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Last Updated: Tuesday, 15 April, 2003, 18:45 GMT 19:45 UK
Ali faces a long road
Ali Ismail Abbas
Ali Ismail Abbas needs much medical care
Advances in medical technology mean that 12-year-old Ali Ismail Abbas may be able to aspire to living a relatively normal life - but the road ahead is a tough and uncertain one.

The Iraqi boy lost both his arms in a coalition air raid on his home in Baghdad.

He was airlifted to Kuwait for emergency medical treatment this week amid warnings that without advanced care he could die of blood poisoning.

If he comes through that, then it is likely that he will be fitted with prosthetic upper limbs.

He would then face a long period of rehabilitation and therapy to learn how best to make use of the equipment, and to come to terms with his condition psychologically.

Stan East, an expert in upper limb prosthesis at prosthetics manufacturer RSL Steeper, told BBC News Online the prognosis for Ali would depend greatly on the extent of his injuries.

Different types

There are three types of prosthetic arm currently available.

A cosmetic arm has little function but, as the name suggests, is designed to look as natural as possible.

It is lightweight and will not usually contain any moving parts. However, it can be used to support objects.

A working arm is a mechanical device that can provide the user with a certain amount of functionality. It can be operated through the use of a simple harness, or by the use of electricity.

And a myoelectric arm uses state-of-the-art technology to stimulate the remaining muscles to provide subtle movement.

Unfortunately, this last type is not an option for people like Ali, who have had both arms amputated well above the elbow - a condition known technically as a transverse humeral deficiency.

This is crucial, because it can be very difficult to try to replicate the complex actions performed by the elbow joint.

Mr East said the best bet for Ali would be to fit two working arms.

These come with a variety of different attachments including a gripper and a device for using a steering wheel.

Injuries a crucial factor

For the first year it will just be about getting his head around what has happened to him, and then the rehabilitation will really start
Lyn Simpson
However, just how much use he could make of the technology would depend on the extent of his injuries, and how well his wounds respond to treatment.

The more damage done to the nerves and muscles at the top of his arms, the harder will be the road to recovery.

"He would need to go through treatment with an occupational therapist," Mr East said.

"We make all sorts of different devices which he could potentially make use of. For instance, you could put a split hook on the end of the arm and put a pen in it, and he could potentially learn how to write."

Amputation rehabilitation programmes vary greatly depending on the individual case.

However, they can include activities to help improve motor skills, and to improve muscle strength, endurance, and control.

An occupational therapist can help teach amputees basic life skills such as washing, feeding and dressing.

Therapists may also focus on how best to manage pain, including phantom pain which may appear to occur below the level of the amputation and can range from pins and needles to an agonising sensation.

And counsellors can help deal with the profound psychological trauma.

Taking it slowly

Lyn Simpson, an occupational therapist at Rookwood Hospital, Cardiff, told BBC News Online that it would be important not to try to rush Ali's therapy.

She said: "It must be taken gradually. For the first year it will just be about getting his head around what has happened to him, and then the rehabilitation will really start.

"It really is important not to take things too quickly because often people in his situation will have an initial adrenalin rush that keeps them going for a few months, and only then does it really hit them what has happened."

Ms Simpson said that losing an arm was often a more upsetting experience than losing a leg.

"A leg is functional, but the arms are used for so many other things, for instance as an expression of love, and to illustrate points when you speak," she said.

She also said it could be some time before Ali is able to use a prosthetic arm, because of the scarring and swelling associated with his injuries.

In the meantime, he will probably be taught how make maximum use of his feet and shoulders for everyday activities.

It was also important that he met other amputees of a similar age so he could be shown how others have overcome their disabilities.

Ms Simpson said: "It's going to be very, very tough for him, but there is a light at the end of the tunnel."




SEE ALSO:
Kuwait ready to treat Iraqi boy
15 Apr 03  |  Middle East


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