Iranian Rehabilitation Journal
Volume:21 Issue: 53, Mar 2023

This study aims to comparatively review the rehabilitation information systems in 8 countries: Canada, the United States, the United Kingdom, Sweden, Australia, Malaysia, Russia, and Iran.

A comprehensive review of published studies without a time limit was explored by searching the keywords, titles, and abstracts. Studies were obtained from the Web of Science, Scopus, PubMed, and Embase databases on May 2, 2021. We also did a Google search engine to explore rehabilitation information system websites in each country. The inclusion criteria included all English and Persian articles in the field of rehabilitation information registration systems or minimum data sets and the availability of complete text of the articles. A total of 13151 related studies were extracted and finally 25 main articles and 6 websites were selected. A similar standard checklist was used to extract and compare the findings. The data items in this checklist included reference, country, registry name, established year, founder, scope, standard classification systems (coding system), data elements, and subcategories of data elements of the registry.

The literature review revealed that the United States has international rehabilitation outcomes in three areas of inpatient, outpatient, and pediatric rehabilitation that collect data from around the world. Australia has a national clinical registry for outpatient and inpatient rehabilitation outcomes for adults and children. Canada, with its national rehabilitation reporting system, gathers only adult inpatient rehabilitation information. In sweden, the Swedish Rehabilitation Medical Register includes rehabilitation activities in both inpatient and outpatient care. Rehabilitation in Malaysia with no data sharing and integration is still in its infancy. The rehabilitation information system in the UK only includes specialized rehabilitation services. In Iran, the Welfare Organization registers and collects (inpatient, outpatient, and home care) rehabilitation and financial data of the disabled with the “payment” system. In Russia, only some studies have proposed the launch of a rehabilitation information system.

The results of this literature review demonstrate that the most comprehensive rehabilitation information systems first belonged to the United States, and then to Australia, Canada, Sweden, the United Kingdom, and Iran in descending order. Meanwhile, a rehabilitation information system is being developed in Malaysia. However, Russia has not yet developed a comprehensive rehabilitation information system.

Sensory processing patterns can be related to children's preferences for various activities. Still, our understanding of how different sensory processing patterns are related to children's participation in leisure activities is fairly limited. Therefore, this study aimed to investigate the association between sensory processing patterns and children's participation in leisure activities.

In this systematic review, the PRISMA (The Preferred Reporting Items For Systematic Reviews And Meta-Analyses) Guidelines were followed. We searched PubMed, Google Scholar, Springer, ProQuest, Scopus, Cochrane Library, Medline, OT Seeker, SID, and Healio databases using the following keywords: “Participation”, “leisure”, “play”, “sensory processing”, “sensory integration”, “sensorimotor”, “sensory”, and “children”. A total of 5040 articles were found, of which 5027 were eliminated after the review, and finally, 13 articles were included in the study based on the inclusion criteria; 6 of them entered the meta-analysis process. The meta-analysis was performed using CMA software. 

The meta-analysis of 6 studies illustrated a significant correlation between the energy level and desire to participate in leisure activities, the auditory-visual sensitivity and willingness to participate in leisure activities, the sensory processing patterns and the intensity of involvement in leisure activities, the general sensory processing and desire to participate in leisure activities, the sensory processing patterns and desire to participate in informal activities, the olfactory sensitivity and desire to participate in leisure activities, the auditory filtering and desire to participate in leisure activities, the sensory processing patterns and enjoyment of participation in leisure activities, and finally sensory processing patterns and desire to participate in recreational activities. 

The evidence in articles on sensory processing patterns and participation in play and leisure activities is inadequate. The only conclusion drawn from all patterns of sensory processing is the significant relationship between these patterns and the preference to participate in recreational activities (which is just one of the several leisure activities).

The COVID-19 outbreak has considerably affected various aspects of our lives and different groups of society. In this regard, healthcare staff is more affected by the pressure of heavy workloads and daily exposure to suspected COVID-19 cases. This study aimed to investigate depression and anxiety as two basic factors of mental health among healthcare workers and the role of self-compassion and cognitive flexibility during the pandemic. 

A multi-center cross-sectional study was conducted. Healthcare workers were the target group, and the samples were collected through the online groups from healthcare staff of coronavirus hospitalized centers in Tehran. A convenience sampling method was used in this study. The general anxiety disorder-7 scale, patient health questionnaire, cognitive flexibility inventory, and self-compassion short-form scale were used online for data collection. Totally 551 respondents were entered into the analysis process of the current study. 

A total of 437 respondents (79.3%) had mild to severe anxiety symptoms, and 447(81.1%) had mild to severe depressive symptoms. Cognitive flexibility had a significant negative relationship with anxiety and depression (r=-0.40, r=-0.37, respectively, P<0.001). Similarly, the relationship between self-compassion and anxiety and depression was significantly negative (r=-0.48, r=-0. 47, respectively, P<0.001).

This study demonstrates the positive effects of cognitive flexibility and self-compassion on healthcare staff during COVID-19.

The presence of skilled, motivated therapists is critical to meet the rehabilitation needs of children with disability. This study aimed to determine whether on-the-job training on applying goal attainment scaling (GAS) affects pediatric occupational therapists' burnout and job motivation.

This study was quasi-experimental with a pre-test-post-test design. After signing the informed consent, 35 pediatric occupational therapists at a child rehabilitation center attended a course of five 1.5-2 h workshop sessions during 5 consequent weeks on applying GAS in their workplace. Through the workshop, the trainees practiced setting goals and making 5-point scales to measure the degree of reaching those goals. The participant asked to bring some of their client's descriptions (anonymous) to the workshop as samples to talk about them. Afterward, they were asked to fill in the GAS documentation form as part of their rehabilitation records. Participants' job motivation and burnout scores were measured by the Maslach questionnaire and Loudahel Kitchener's Job Motivation Scale, respectively, before the workshop and 30 and 60 days later. The paired t-test and Wilcoxon test were used for comparisons. 

The Mean±SD job motivation scores, which were 42.37±6.73 before the intervention, rose to 52.82±8.51 and 56±7.59 at the end of the workshop (day 30) and on follow-up measurement (day 60), respectively (P<0.001). The effect size was 0.556. The burnout scores slightly decreased from 58±12.86 before the intervention to 55.37±12.07, with an effect size of 0.117 on day 60 measurements.

A short on-the-job training workshop on applying GAS in the formal assessment of achievements in different aspects of child life by rehabilitation practices could help in enhancing therapists' job motivation. Positive effects of GAS administration on motivation and burnout in therapists should take into account along with the client benefits for judging the usefulness of the GAS.

Attention-deficit/hyperactivity disorder (ADHD) is highly common in children and can continue lifelong. Looking at children's participation in detail is excessively important since it affects their quality of life (QoL). The Iranian children's participation assessment scale is a questionnaire that determines children's participation and is primarily built for children with cerebral palsy. This study aims to estimate the psychometric properties of this questionnaire for children with ADHD.

The content validity was estimated using the Lawshe method with 8 occupational therapy experts (5 with a PhD and 3 with a MA degree with at least 5 years of experience). Test-retest reliability was done using an intraclass correlation class (ICC) in a two-week interval among 30 children with ADHD.

Regarding content validity, CVI was found to be 1 for all items, and CVR values were between 0.75 and 1 for all items. Regarding reliability, the ICC result was 1 for all the items.

No item was omitted in the validity part, and all items showed good reliability. The test is valid and reliable for children with ADHD.

The current study was performed to determine the validity and reliability of the Persian version of the Khalfa Hyperacusis questionnaire (HQ) and its differential validity between normal people and patients with hyperacusis or tinnitus.

The international quality of life assessment (IQoLA) method was considered for the translation process. After determining face and content validities of the Persian version, 81 patients with hyperacusis and or tinnitus (22 participants with hyperacusis, 18 with hyperacusis and tinnitus and 41 with tinnitus) with a mean age of 40±2.9 years and 80 normal people with a mean age of 36.9±1.31 years were tested for reliability and differential validity for clinical use. The reliability of this questionnaire was tested through the test-retest method in all participants of both groups with an interval of two weeks.

The content validity ratio and content validity index approved the face validity of the Persian version of the HQ. The average total score for patients in group 1 was 21.3, significantly higher than 3.75 for the normal group. A high total score Cronbach coefficient was found to be 0.90, which approved the internal consistency of the HQ. The cut-off point of the questionnaire was estimated to be 17.5 for the total HQ score in the Persian version. The Persian version of the HQ shows high reliability with an intraclass correlation coefficient of 0.97.

The Persian version of the HQ showed high validity and reliability, which suggests its usefulness in hyperacusis clinics. A total HQ score of 17.5 or more is indicated as a cut-off point for classifying hyperacusis patients. Further studies on other populations are suggested for generalizing the results.

We aimed to assess anxiety in pregnant women. We also investigated the probably associated factors in anxiety in pregnant women. 

This research is a descriptive correlational study. The samples (209 pregnant women) were recruited by non-probability (purposive) sampling, and the study instrument consisted of the Hamilton anxiety rating scale and interviews with mothers. The obtained data were analyzed by SPSS softwer, version 25.

Most respondents were 17-26 years old, and around half were satisfied with their income. Studies show a significant positive correlation between anxiety and gestational age, watching TV, sleeping, and drinking tea. 

Anxiety increased with mothers working and with mothers with low socioeconomic status. About 26.3% of pregnant mothers had severe anxiety. Some habits like drinking tea, sleeping, and watching TV increase when anxiety increases.

This study was done to find out the impact of a pre-operative physical therapy plan with inspiratory muscle training on functional capacity, kinesiophobia, and post-operative intensive care unit (ICU) stay in subjects with coronary artery disease (CAD) candidates for coronary artery bypass grafting (CABG).

Fifty subjects who fulfilled the inclusion criteria were recruited and randomly distributed into the intervention and control group by concealed envelop method. Participants in the experimental group were provided with inspiratory muscle training (IMT) with breathing exercises and chest clearance techniques, while the control group received breathing exercises and chest clearance techniques. Both groups received three treatment sessions before their scheduled surgery. The assessment was done at three-time intervals: At baseline, after three sessions, and after surgery. The outcome measures were oxygen saturation, heart rate, respiratory rate, Borg scale of perceived exertion (Borg PRE), Tampa scale of kinesiophobia for the heart (TSKH), and days spent at ICU after CABG.

Oxygen saturation, respiratory rate, functional capacity, and pulmonary endurance improved significantly among the treatment groups with a P<0.001 and a large effect size. The pulse rate showed no significant improvement; P and effect size were 0.38 and 0.60, respectively. Kinesiophobia and ICU stay also showed significant changes with a P<0.001. The effect size was large for both kinesiophobia and ICU stay. 

IMT as a component of a pre-operative physical therapy plan can improve oxygen saturation, respiratory rate, functional capacity, and pulmonary endurance in CAD patients going for CABG. IMT reduces the level of kinesiophobia and duration of ICU stay after CABG.

This study was done to assess the spread of bad habits among juvenile convicts and determine the motives for use and the consequences of addiction.

This study was descriptive and carried out at the Federal State Healthcare Institution. The study group included 106 adolescents aged 14 to 19 years. Sample selection was based on a multi-stage sampling method. The research tool was a questionnaire and changes were made according to the study population it covered all the important aspects of the concept being measured. To analyze data, SPSS software, versio16 was utilized.

A total of 92 convicts out of 106 had bad habits. Drugs were taken by 30 adolescents, alcohol use was reported by 72 teenagers, and nine teenagers were smokers. Ten adolescents who took surfactants were registered with the narcologist. Twenty convicts were treated by psychiatrists. Most of the convicts using various psychoactive substances experienced serious learning difficulties and 17 teenagers had aggravated heredity in alcoholism and drug addiction.

Adolescents admitted to penitentiary institutions are characterized by a significant increase in harmful addictions, which subsequently affect their mental and somatic health and contribute to the formation of an asocial personality.

The urgency of the given study is in the lack of knowledge of various types of motor abilities of older pre-school children with speech disorders and the need to realize an individually differentiated approach to provide the environment for their development. In the current study, it was tried to identify and assess the level of development of motor abilities in older pre-school children with speech disorders. 

The study included 200 older pre-school children, 100 children with a healthy level of speech development, and 100 with a speech disorder in the Belgorod and Belgorod region (Russian Federation). The study looked at scientific sources using motor abilities testing (motor coordination, speed, strength, strength, plasticity, and stamina). Methods of mathematical statistics (student's t-test) using the SPSS software, version 26 were used to calculate the statistic problems. 

The study and assessment of motor abilities of older pre-school children showed the predominance of an insufficient level of development of motor and coordination abilities in both neurotypical children and those with a language disorder. In both groups, children performed the worse left-hand task (the insufficient level was noted in children with speech disorders in 100% of boys and girls; in the group of children with a healthy level of speech development – in 84.1% of boys and 81.5 % of girls). When performing the right task hand, an insufficient level was noticed in children with speech disorders in 95.5% of boys and 96.4% of girls; in the group of children with a healthy level of speech development–in 77.3% of boys and 74.1% of girls. Diagnosis of other motor abilities states the dominance of the insufficient level only in children with speech disorders: strength abilities (70.5% of boys and 72.3% of girls), speed and strength abilities (68.2 % of boys and 67.9 % of girls), stamina (77.3% of boys and 75% of girls), and plasticity (65.9% of boys and 62.5% of girls). The veracity of the results was confirmed through the student's t-test. The observed differences were statistically significant. 

The obtained findings and assessment of motor abilities confirm developmental lag in older pre-school children with speech disorders. In children, low indicators in the level of development of motor-coordination abilities and stamina prevailed.

We evaluated the optimal duration of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) patients.

This cross-sectional study was conducted at Cipto Mangunkusumo Hospital from November 2018 to June 2019. We recruited 55 subjects diagnosed with SUI based on the questionnaire for urinary incontinence diagnosis (QUID) score >4 and more than 2 grams of 1-hour pad test. Considering the inclusion and exclusion criteria, we taught and supervised them for PFMT and evaluated them every four weeks to observe the urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), 1-hour pad test, and perineometer score. We used the Wilcoxon test to evaluate the improvement at a significance level of P<0.05.

Our subjects were mostly obese (65%), 30-55 years old (60%), and had >2 children (90%). There were improvements in UDI-6 and IIQ-7 for every four weeks up to 12 weeks of PFMT (P<0.05, 95% CI). Pelvic floor muscle strength only improved significantly (P=0.001 and P=0.006, respectively) after eight weeks of PFMT. Also, the 1-hour pad test score decreased significantly after four weeks of training (P<0.001). 

SUI distress and symptoms decrease after four weeks of Kegel exercises and continue to improve until 12 weeks of therapy. However, the 1-hour pad test reaches clinical and statistical significance during the first month of exercise with no further improvement clinically. Pelvic floor muscle strength increased significantly after eight weeks of training.

Sexual harassment is one of the most common workplace issues that female employees may experience. The issue is especially severe for women working in a healthcare setting due to factors, such as unequal hierarchical power, night shifts, and a significant volume of visitors, etc. This study sought to characterize and categorize responses to and causes of acute sexual harassment.

Thirty-nine hospital employees who had experienced sexual harassment were selected for in-depth interviews as part of a qualitative study designed to collect data. 

The responses were categorized chronologically as pre-, during-, and post-harassment. Preventive strategies were the most notable pre-harassment responses, whereas, during harassment, diffusion, denial, avoidance, and behavioral changes were the most significant responses. Nonetheless, since diffusion, avoidance, non-disclosure, and non-reporting could result in the persistence of the harassment, the post-harassment strategies shed light on the factors that determined the victims' failure to disclose sexual harassment.

Although women experience sexual harassment in healthcare settings, they typically refrain from reporting it and respond passively to such situations. Formal and informal organizational support for the harassed women can empower them to resist harassers and report their conduct in hospital settings.

Hallux rigidus is one of the main etiologies of disability in the elderly. It is a degenerative disease of the first metatarsophalangeal joint causing restriction of movement as well as pain and swelling. This study was conducted to evaluate the effectiveness of methylprednisolone and dextrose prolotherapy in pain reduction and functional improvement of patients with hallux rigidus.

A randomized double-blind control trial was designed with the inclusion of 32 patients assigned to the two groups. Group one received a mixture of 1 cc methylprednisolone 40 mg with 1 cc lidocaine 2% while the second group received a combination of 1 cc dextrose 50% with 1 cc lidocaine 2%. Standard questionnaires, including visual analog scale (VAS) and Manchester-Oxford foot questionnaire (MOXFQ) were completed by all patients at baseline and 1, 4, and 8 weeks after injections.

Both groups revealed significant improvement in VAS and MOXFQ scores 1, 4, and 8 weeks post-injection with no difference between the two groups in the follow-up.

Both corticosteroid injections and prolotherapy are effective in pain reduction and functional improvement in patients with hallux rigidus but neither is superior to the other.

The aim of the study was to assess the sleep characteristics among patients with chronic liver diseases (CLDs) and find the relationship between variables of their demographic and sleep disorder.

This descriptive cross-sectional study was designed to achieve the stated goals of patients with CLD in the Al-Najaf Center for Gastroenterology and Hepatology in Al-Sadr Medical City from November 1, 2020, to June 1, 2021. The sample was selected from 120 adult patients ≥18 years using non-probability sampling (purposeful) with CLD (disease duration of six months or more) . The questionnaire consisted of two socio-demographic parts with clinical data (18 items) and a general health questionnaire (28 items) with 4 implicit subscales, including insomnia and anxiety level.

There was a strong significant relationship between sleep disorder and age (P=0.001), occupational status (P=0.001), daily activity (P=0.001), BMI (P=0.001), and duration of disease (P=0.001), gender (P=0.021), educational level (P=0.04), marital status (P=0.049), and type of disease (P=0.01). However, there was no significant relationship between sleep disorder and the remaining demographic and clinical data.

In conclusion, there is a relationship between the sleep disorder of CLD patients and their socio-demographic data. There is a strong significant relationship between patients’ physical status and their sleep disorder (P=0.001). This result means that the disease has a significant effect on sleep.

The patient evaluation measure (PEM) evaluates the hand health profile. Having an appropriate measurement tool for the assessment of hand outcomes in Iranian individuals with wrist disorders is essential for clinical and research settings. The objective of the present study was to examine the psychometric features of the PEM in Iranian individuals with wrist disorders.

Ninety individuals with wrist disorders were recruited. Hand outcome was evaluated with the PEM, quick-disabilities of the arm, shoulder, and hand (Q-DASH), visual analogue scale-pain (VAS-P), and JAMAR hand-grip dynamometer. The PEM was translated into Persian. Face, content, and convergent validity was examined. Also, acceptability, internal consistency, test-retest reliability, and absolute reliability were calculated.

All questions had an item impact score and CVR score of >1.5 and >0.42, respectively. All questions except for question 1 (CVI=0.76) and 10 (CVI=0.73) of section B had a CVI score of <0.79. After changes were applied, the CVI score for these questions (question 1=0.83; question 10=0.87) reached acceptable criteria. The total score of the PEM showed a significant moderate correlation with Q-DASH (ρ=0.51; P<0.001) and VAS-P (ρ=0.55; P<0.001) and an insignificant weak correlation with grip strength (ρ=-0.11; P>0.05). Floor and ceiling effects were 0% for the total PEM score. The Cronbach’s α and intra-class correlation values were 0.72-0.87 and 0.96-0.98, respectively. 

The present study suggests that the PEM has acceptable validity and reliability for measuring performance and satisfaction in individuals with wrist disorders. This measure might contribute as an outcome measure in research and routine assessments in clinical practice.

The present cross-sectional study was done to acknowledge the level of resilience, its association with quality of life (QoL), community integration, and demographic/injury-related variables, and identify the determinants that affect resilience among spinal cord injury individuals living in the community.

The data were collected from 108 participants using the convenience sampling method. A demographic/injury-related questionnaire was used to identify the characteristics of the participants. The CD-RISC10, World Health Organization quality of life-BREF (WHOQOL-BREF), and community integration questionnaire-revised (CIQ-R) were used to measure resilience, QoL, and community integration. Association between resilience and independent variables was examined through Pearson’s correlation and Point-Biserial correlation, whereas, univariate and multivariate linear regression analyses were applied to identify the influence of the demographic/injury-related factors that contribute to resilience, and independent t-test and ANOVA were employed to identify the determinants that affect resilience.

Almost 78% of participants had a moderate-to-high level of resilience. In multivariate analysis, gender, marital status, and profession were found to be statistically significant. Among these predictors, employment had a higher beta value (β=0.684, P=0.026), which signifies its importance in evaluating resilience. Significant associations were established between resilience, QoL domains, community integration, and demographic variables, which included marital status, duration since the injury, and frequency of going out.

The present research brings attention to the significance of using appropriate interventions, such as vocational rehabilitation support as well as awareness about the injury to help strengthen resilience and reintegration amongst SCI individuals into their communities. A further longitudinal study is recommended to determine predictive factors of the dynamic nature of resilience over time.

Lexical access problems are one of the limitations observed in children with developmental language disorders during the initial years of schooling. Semantic context has a powerful influence on lexical access. The cross-modal visual-auditory picture-word interference paradigm is a method for studying adults and children's lexical access. Because few studies have examined lexical access in Persian-speaking children, the present study aimed to investigate the effect of different semantic contexts on lexical access in children with and without developmental language disorder. 

In this experimental study, 20 children aged 7-9 years with developmental language disorders and 20 age-matched peers were recruited according to the inclusion and exclusion criteria. At first, the picture-word interference paradigm was prepared. In so doing, 16 common pictures of objects paired with four auditory interfering words (related verb, related noun, unrelated verb, and unrelated noun) were presented to the children in a silent condition to determine their naming accuracy and latency. The DMDX software calculated the naming latency. The percentage of correct names also calculated naming accuracy. 

Naming latencies were significantly faster in children without language disorders (P≤0.05). In addition, a reliable interference effect was found. According to the results, naming latencies were significantly faster for related verb distractors than unrelated verbs and related noun distractors (P<0.05). In addition, a significant difference was observed between the silent and interference conditions regarding the naming accuracy. However, accuracy was not affected by distractors. 

Different semantic contexts affect lexical access differently in children. These differences cause semantic relatedness between verbs and nouns in lexical networks. The present study findings indicate that lexical knowledge and semantic relatedness are lower in children with developmental language disorders than in those with typical language development. These results can be useful for future studies and interventions on lexical access in children with and without language disorders.

To determine the association between cervical radiculopathy and quality of life (QoL) in patients with cervical spondylosis.

This analytical cross-sectional study was conducted on 273 patients in five hospitals in Lahore within 3 months from April to June 2021. The Spurling test was used to measure cervical radiculopathy. The participants were selected according to the inclusion criteria. The Spurling test was used to measure cervical radiculopathy and its symptoms. The World Health Organization quality of life scale (WHOQoL) was used to evaluate the QoL of patients suffering from cervical spondylosis. 

Of 273 patients, 42.9% were male and 57.1% female. Their Mean±SD age was 42±11.9 years. Also, 70.3% had positive Spurling test, and 29.7% had negative results. Their Mean±SD physical health score was 11.70±1.74 (out of a total of 20), and their Mean±SD psychological health score was 11.75±1.78 (out of a total of 20). The Mean±SD social relationships score was 11.19±2.98 (out of a total of 20), and their Mean±SD environment health score was 11.13±3.08 out of a total of 20. P indicates a significant difference in the QoL between patients with positive and negative Spurling tests. Patients with negative Spurling tests had higher QoL scores. Greater scores denote a higher QoL

There is a significant association between cervical radiculopathy and QoL in patients with cervical spondylosis. These results will help us in the future to design educational programs or modify the lifestyle of those patients with cervical radiculopathy. This research concluded that there is a significant difference in the QoL among patients with positive and negative Spurling tests. Patients with negative Spurling tests have higher QoL scores. Hence there is a significant association between diagnosed cervical radiculopathy and QoL.

Multiple limb amputations are an uncommon complication from inotrope-induced peripheral gangrene.

A 20-year-old lady with valvular heart disease had septic shock secondary to infective endocarditis and required prolonged cardiopulmonary resuscitation. Despite aggressive fluid resuscitation, the patient had triple strength intravenous noradrenaline to maintain hemodynamic stability. On day 5 of post-shock, dry gangrene occurred in distal parts of all limbs, and inotrope was stopped. Although the gangrenous changes were non-progressive, she required a significant degree of assistance with mobility and daily function performance. The patient was counseled for multiple limb amputations to promote walking and hand function through prosthetic restoration. Five months after the event, she had a right transtibial amputation, left Chopart amputation, left wrist disarticulation, and right second, third, fourth, and fifth fingers amputation. Three specific goals for inpatient rehabilitation were independent short-distance ambulation with prostheses, performing basic activities of daily living with adaptive devices, and independent wheelchair propulsion for long-distance mobility using a right-sided transtibial prosthesis, left-sided Syme's prosthesis with Kingsley's foot, right-sided silicone-based cosmetic glove and left-sided body-powered transradial prosthesis.

Although an uncommon complication, inotrope may lead to multiple limb amputations secondary to peripheral gangrene. Following amputation, the ultimate rehabilitative goal is to restore the mobility and capacity to perform daily functions through prosthetic restoration, whether walking for lower amputees or functioning hand for upper limb amputees. Prescribing prosthesis in a single limb loss is relatively straightforward, but restoring multiple limb amputations bears many challenges toward successful recovery of walking and functions.