Nottingham foot specialist 'lied about knowledge'

NewsBot · Feb 23, 2009

Members do not see these Ads. Sign Up.
Nottingham.co.uk are reporting:
Nottingham foot specialist 'lied about knowledge'

A LADY BAY foot specialist lied about his knowledge of keyhole surgery to boost his professional status, a misconduct hearing has been told today.
Amin Sain placed an advert in the Yellow Pages claiming competence in the cutting edge surgical technique, despite not having the right qualifications to practise it, the hearing heard.
He also falsely claimed membership of the General Podiatric Surgery Council on a website, a panel of the Health Professions' Council in south London was told.
Sain, of Trent Boulevard, West Bridgford, admits practicing keyhole surgery but denies that this constitutes misconduct.
He also denies a second charge that his fitness to practise is impaired.
Sophie Kemp, for the HPC, said Sain's claims were misleading and of concern to the regulatory body.
She said keyhole, or minimally invasive surgery, required an extensive knowledge of surgery, anatomy and pharmacology - none of which Sain had to the right level.
"Anyone who's practising this type of surgery should have advanced training to perform safely," she said.
"It's the council's case that Sain didn't have the surgical knowledge necessary. Podiatrists would get this by undertaking a rigorous course - a course that quite simply Mr Sain hasn't completed."
Miss Kemp added that Sain's defence to the allegation appeared to have changed recently.
She said the podiatrist acknowledged he was not a fully qualified surgeon, but argued that this did not matter, claiming that what did was his competence in keyhole procedures.
Sain also faces a second charge that he lied about membership of the General Podiatric Surgery Council.
Miss Kemp said a member of the council was last year monitoring external websites when she came across Sain's.
The site claimed he was regulated by the society and was also a member.
Miss Kemp said this was untrue, and added that when Sain was confronted with the lies, he said the site was not owned by him.
"He denies he set it up," she said.
"However, you can draw an inference about Mr Sain's involvement because of the close connection between himself, and the details of his name on the website."
Sain claims he has the appropriate experience from time in the US, France and Spain, and is even a leader in the field.
If the charges are proved, he could be thrown out of the podiatric profession.
The hearing continues.
Click to expand...

Craig Payne · Feb 23, 2009

NewsBot said: ↑

Miss Kemp said this was untrue, and added that when Sain was confronted with the lies, he said the site was not owned by him.
"He denies he set it up," she said.
"However, you can draw an inference about Mr Sain's involvement because of the close connection between himself, and the details of his name on the website."
Click to expand...

Interesting claim, given that he owned the domain name! (see this thread).

I just checked a whois and the domain is no longer registered.

BUT, look at this from Wayback archive of the site:
http://web.archive.org/web/20050205065747/http://www.gpsc.org.uk/

THE COLLEGE OF MINIMALLY INVASIVE FOOT AND ANKLE SURGERY
Our web address has changed to
http://web.archive.org/web/20050205065747/http://www.cmifas.co.uk/
amin.sain@ntlworld.com
Click to expand...

...and he claims he has nothing to do with the site! BUT, clearly at some stage in the past (according to the wayback archive) the General Podiatry Surgery Council site directed visitors to his email address and the CMIFAS site!

A Whois enquiry of cmifas.co.uk, show he owns the site!:
http://webwhois.nic.uk/cgi-bin/whois.cgi?query=cmifas.co.uk&WHOIS Submit.x=40&WHOIS Submit.y=9

Domain name:
cmifas.co.uk

Registrant:
Mr. Amin Sain

Trading as:
College Of Minimal Invasive Foot and Ankle Surgery LTD

Registrant type:
UK Limited Company, (Company number: 5305429)
Click to expand...

The GPSC website ("The UK regulatory body for Podiatric Surgeons") from Nov 2004 had him listed as the UK director:
http://web.archive.org/web/20041128080154/http://www.gpsc.org.uk/

I wonder if the HPC have all this information?

DAVOhorn · Feb 24, 2009

Dear Craig,

If they did not then thanks to your due diligence they could now as this site is in the Public Domain.

I remember when this was all hitting the fan as i read about his activities on this site.

regards David

joseph Paterson · Feb 24, 2009

An article in the "Journal" dated 8 July 2004 from the Alliance about "A Minimal Invasion of America states that Mr Amin Sain FAAFAS (USA) Podiartic Surgeon, Fellow of the Amerericain Ambulatory Foot and Ankle Surgery and now Podiatric Director of AAFAS (UK)" I remember reading the website at the time thinking that this may be new!only to find out later the Podiatric Surgeons used this type of surgery over 30 years ago plus it was an expensive course, which of course put me off. One is lead to believe that his qualifications are American, but if not recognised by the HPC then he would remain unqualified and not able to use his skills in the uk.

This case does raise the question, is it worth it to go abroad to learn more.

At the time of writing I have no knowledge of the out come of the hearing.

Joseph

William Fowler · Feb 24, 2009

Joseph, if you look at thus thread http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=338 , they weren't actually qualifications and he was trying to call himself Dr.

NewsBot · Feb 24, 2009

Here is the latest:
'Fake doctor' on misconduct charge

A FOOT specialist who claimed he was a doctor and an expert in keyhole surgery had only ever practiced on dead bodies, a misconduct hearing was told today.
Amin Sain, 36, made the claims in the Nottingham Yellow Pages when he had completed just 26 days of training, the Health Professions Council heard.
Sain, whose practice is at Trent Boulevard, West Bridgford, told the hearing that 30% of his patients need keyhole surgery.
He said he built up his experience from time in America and Spain.
But Sophie Kemp, for the HPC, said this amounted to a few days over several years.
"Most of it was observing and assisting - passing instruments. By the end of May 2004 it was 26 days experience on cadavers," she said.
"You never carried out any operations on live patients."
A fitness to practise hearing before the Health Professions' Council in London was told Sain placed the advert in the 2004/2005 Yellow Pages.
Miss Kemp said the advert said he was a doctor - imply he had a Phd when he did not.
Sain said it was normal to use such a title in Europe and America.
When asked how he could justify claiming expertise in keyhole surgery when he had never practised on patients, he said: "Keyhole surgery was an extension to what I was already doing. I felt I was able to do it."
Sain admits practicing keyhole surgery but claims he has the appropriate experience.
He denies lying on the website and that his fitness to practise is impaired.
The hearing is due to finish tomorrow.
Click to expand...

Admin2 · Feb 24, 2009

For more on the pros and cons, see these threads: Minimally invasive foot surgery

NewsBot · Feb 26, 2009

Here is the HPC decisions:

Committees Finding:

Decision on Facts, Misconduct and Impairment:

1. By decisions of Panels of the Investigating Committee made on 26th March 2005 and 26th May 2005 two allegations have been made against Mr Sain. The first allegation (hereafter referred to as “the MIS allegation”) is that Mr Sain’s fitness to practise is impaired by reason of his misconduct in that he has been practising minimal invasive surgery without the full underpinning surgical knowledge necessary to perform that type of surgery safely, and that in doing so he was acting beyond the scope of his practice. The second allegation (hereafter referred to as “the website allegation”) is that Mr Sain’s fitness to practise is impaired by reason of his misconduct in relation to the content of a website for the General Podiatric Surgery Council.

2. The task of the Panel is to decide whether these allegations are well founded. In order to do this it is necessary for the Panel to approach the matter in the following manner:
a. First to decide what facts falling within the parameters of the allegations have been proved.
b. To the extent that relevant facts have been proved, then to decide if those facts demonstrate misconduct on the part of Mr Sain.
c. If, and only if, misconduct is established, then to decide if that misconduct is currently impairing Mr Sain’s fitness to practise. It is only if there is current impairment of fitness to practise that an allegation will be well founded.

3. In connection with the approach taken by the Panel there are three further matters that should be mentioned:
a. First, the Panel has remembered throughout its deliberations that so far as all disputed factual matters are concerned it is for the HPC to prove matters against Mr Sain. It is not for Mr Sain to disprove the facts or any element of them. The standard to which the HPC is required to prove disputed facts is the civil standard of the balance of probabilities.
b. Secondly, both the HPC and Mr Sain have introduced the evidence of witnesses by way of written statements and oral evidence. The Panel is satisfied that written evidence is admissible, but it has had in mind when assessing the weight to be attached to that evidence that the witnesses have not been cross examined and that therefore the opposing party has not had the opportunity to put their case to them. The Panel has not had the opportunity to observe the witness when challenged.
c. Finally, the Panel has approached the two allegations as discrete allegations. Proof of one (or of an element of one) has not been taken as relevant in considering whether the other has been proved.
Background

4. Mr Sain graduated in Podiatry in 1992 and was registered in the Chiropody part of the register on 16th July 1992. He subsequently developed an interest in Podiatric Surgery and between 1997 and 1999 he passed elements of the surgical training program then provided by The Society of Chiropodists and Podiatrists (“SCP”). Having successfully completed the penultimate stage of that syllabus Mr Sain would have proceeded to undertake the element that could be summarised as a surgical traineeship. In fact a change effected by the SCP in the surgical training program had the consequence that Mr Sain ran out of time under the transitional arrangements provided for. It is clear from the documents that Mr Sain felt aggrieved by this state of affairs. The facts stated are relevant to the background to both allegations, but the rights and wrongs of the position are not matters which can or should influence the Panel in making its decision.

5. Having found his progress under the old syllabus impossible Mr Sain did not commence under the new training programme established by the SCP. Rather, he decided to approach the matter in another way by attending courses run by, and associating himself with, institutions in the USA and Spain and by attending courses and seminars in those countries and also in France. In doing so he has focused exclusively on MIS, and has not been further trained in traditional open site surgery.
The MIS allegation

6. It is necessary to commence by making clear what this allegation does not involve. The title “Podiatric Surgeon” is not a protected title in the way that “Podiatrist” is undoubtedly protected by the HPC. Further, although mention has been made of the SCP training programmes, neither the old nor the new has been an approved course in the sense in which the HPC approves courses, the passing of which automatically qualifies for registration. These facts have the consequence that the decision of the Panel should not be considered to have any general application. It is necessary to make this point because it has been suggested to the Panel on an earlier occasion (but not by Mr Pascall who has represented Mr Sain at this hearing) that it was undertaking a “test case”. This is not and cannot be a test case. The evidence has been specific to Mr Sain. The task the Panel has been required to undertake is to decide if the specific allegation relating to Mr Sain is well founded. The Panel has no mandate to embark on some general review of training in Podiatric Surgery, and has not received the evidence that would enable it to do so.

7. As already stated, the Panel proceeds on the basis that “Podiatric Surgeon” is not a protected title. However, there cannot be any doubt but that in undertaking MIS Mr Sain has been practising as a Podiatrist and therefore his activities are within the legitimate remit of the HPC and the Panel. That he is working as a Podiatrist is established by the fact that in undertaking MIS he uses local anaesthesia, that use only being lawful by reason of his HPC registration being extended to permit him to do so.

8. In summary the HPC’s case is that the training undertaken by Mr Sain under the old SCP syllabus took him to the level where he could have applied to act as a surgical trainee, but that in undertaking MIS without having acquired the knowledge and skills that such a traineeship would have provided him with, he is working without the full underpinning knowledge. The HPC’s case is that MIS is a valuable tool, but one that is part of the whole range of surgical techniques including traditional open site surgery. The HPC contends that Mr Sain’s acknowledgment that he would not undertake traditional, open site surgery, merely demonstrates his lack of skills to undertake MIS safely. Mr Sain’s case in relation to this allegation is that by a combination of the SCP studies he undertook, together with the steps taken outside the UK he is appropriately qualified to undertake MIS.

9. The Panel finds that the British public have the right to expect that any healthcare professional who performs surgery (of any type) has been trained to a safe and quantifiable standard. There is no proscribed route in Podiatry to obtain such a standard in the UK, but the most usual method is following the SCP route already identified. This is the course of training and examination that is recognised by the N.H.S. and various private healthcare providers. The Panel has heard that there are currently approximately 70 Podiatric Surgeons working in the N.H.S., a number of whom use MIS when appropriate as one of a number of techniques in Podiatric Surgery. As already stated Mr Sain’s progress under the old SCP syllabus undoubtedly took him to the level where he could have commenced a surgical traineeship.

10. The Panel finds that the HPC has demonstrated that in order for someone in Mr Sain’s position to be permitted safely to undertake Podiatric Surgery they would need to be able to demonstrate practical application of theory in a structured programme of hands-on surgical training under the supervision and direction of an appropriately qualified professional who could assess by observation and examination the suitability of that person to practise safely Podiatric Surgery on patients. This would have to be predominately by practise on patients (as opposed to on cadavers or by simulation). The hands-on surgical training should be of sufficient length to enable the trainee to be exposed to a wide range of surgical interventions and for the supervisor to have a sufficient opportunity to assess the candidate’s capability over a range of conditions involving a number of patients.

11. The Panel acknowledges that Mr Sain went some way towards completing a satisfactory training programme and the fact that in this decision the Panel does not recite what he has done should not be taken to suggest that this has been overlooked. Furthermore, the Panel accepts that since he has been undertaking MIS he has been observed on single occasions each by a Podiatrist, a Podiatric Surgeon and an Orthopaedic Surgeon undertaking a limited number of procedures. However, the Panel finds that in circumstances where Mr Sain has not undertaken the wide-ranging supervised traineeship already mentioned, where he has not sought to develop his skills in relation to traditional open site surgery and lacks the ability to supply prescription only medicines to enable him to supply antibiotics, therefore he lacks the full underpinning surgical knowledge to perform MIS safely.

12. As this is an allegation of misconduct the Panel has considered the question whether it has been proved that Mr Sain proceeded to undertake MIS appreciating that he was not fully qualified to do so. The Panel is satisfied that this has been established. Having attempted to embark on the final part of the old SCP syllabus the Panel is satisfied that Mr Sain knew that his subsequent efforts were not equivalent to that stage. The conduct breached standards 1, l3, 6, 14 and 16 of the HPC’s Standards of Conduct, Performance and Ethics.

13. It is therefore necessary to consider whether this misconduct is still impairing Mr Sain’s fitness to practise. The Panel has concluded that it is. This is because having historically embarked on procedures which he knew he was not fully equipped to perform, Mr Sain has not provided the Panel with evidence on which it could conclude that he has developed sufficient insight into the inappropriateness of his actions.

14. It follows that the MIS allegation is well founded.

The website allegation.

15. In November 2004 it was noted that there was a website for a purported body described as the “General Podiatric Surgery Council”. On that website a “Dr Amin M Sain” was described as the UK Director of the General Podiatric Surgery Council. The HPC’s case in relation to this website is that, although he did not register the site, Mr Sain’s association with it was undertaken with his knowledge. Further, it is contended that the site with which Mr Sain knowingly associated himself was misleading because it purported to be for a body that was an established regulator of Podiatric Surgery whereas it was not.

16. Mr Sain’s evidence to the Panel was that he knew nothing of this site. The key to this allegation is to be found in a contribution made by Mr Sain, described as “Dr Amin M. Sain, Director GPSC and College of Minimal Invasive Foot & Ankle Surgery”, to the internet discussion forum, “Podiatry Arena” on 17th November 2004. This was an entry made by Mr Sain. It refers to the CPSC as being “much like a GMC”. Mr Sain stated that he merely copied and pasted an email sent to him but that he was unaware of its contents. The Panel rejects his evidence that he was unaware of its contents. This conduct breached standards 14 and 16 of the HPC’s Standards of Conduct, Performance and Ethics.

17. The knowing association with this website was misconduct. Mr Sain’s continued denial of knowledge of the content on this website has the consequence the misconduct is still impairing his fitness to practise.

18. It follows that both allegations are well founded and the Panel must proceed to consider the question of sanction.

Committees Direction:

Decision on sanction

19. Since announcing the decision set out above that the allegations were well founded the Panel has heard further submissions on sanction.

20. The Panel has had in mind throughout its deliberations that the purpose of a sanction is not to punish. Rather, a sanction is only to be imposed to the extent that it is required to protect the public and to maintain confidence in the profession of Podiatry and in the HPC’s regulatory function. As misconduct has been found the whole range of sanctions is available up to and including striking-off.

21. The Panel has approached the issue of sanction on the basis that one sanction is required notwithstanding the fact that two distinct allegations have been found. The misconduct found is too serious to result in no further action or a caution order. The Panel has approached the sanctions in an ascending order of gravity and has concluded that the only two sanctions that could be appropriate in this case are conditions of practice and striking-off. This is because a suspension order would achieve no useful purpose.

22. It is appropriate to record the fact that no criticism has been advanced of Mr Sain’s ordinary, non-surgical, Podiatric work. The Panel has concluded that provided Mr Sain could be relied upon to comply with a conditions of practice order. Such an order would be appropriate and sufficient to afford proper protection for the public. With this in mind the Panel reconvened in public session and invited Mr Sain to give further sworn evidence. In doing so he assured the Panel that he would comply with a conditions of practice. The prohibition contained in the order is set out below. The appropriate length of that order is the maximum period of 3 years because in the view of this Panel unless and until Mr Sain overcomes the deficiencies identified by the decision on the MIS allegation he should continue to be prohibited from undertaking Podiatric Surgery for the remainder of his career.

Order:
That the Registrar be directed to annotate the register entry of Amin M. Sain to show that, from the date that this order takes effect (“the operative date”) and for a period of 3 years, Mr Sain must not perform any type of Podiatric Surgery. For the avoidance of doubt this prohibition does not prevent Mr Sain from performing partial or total nail resection and removal, with chemical destruction of the tissues.
Click to expand...

Link

Craig Payne · Feb 26, 2009

NewsBot said: ↑

The key to this allegation is to be found in a contribution made by Mr Sain, described as “Dr Amin M. Sain, Director GPSC and College of Minimal Invasive Foot & Ankle Surgery”, to the internet discussion forum, “Podiatry Arena” on 17th November 2004. This was an entry made by Mr Sain. It refers to the CPSC as being “much like a GMC”.
Click to expand...

Cool .....

LuckyLisfranc · Feb 26, 2009

I find this an interesting test case on the role of additional surgical procedures complementing the current limited surgical scope of general podiatrists in Commonwealth countries.

Similar to organised medicine and dentistry, there is skepticism on the ability of 'general' practitioners to learn additional surgical procedures beyond just simple nail procedures and wart surgery. An example might be a percutaneous flexor tenotomy for an apical toe neuroapthic ulcer, performed on an outpatient basis in a just few seconds with next to no equipment. My local orthopaedic surgeons charge a staggering amount for these on diabetic patients (done in theatre with a reasonable sedation/GA) with chronic toe lesions, when general podiatrists could easily be doing these safely, at massively lower cost, and with a greater public health benefit (my contention).

The debate on MIS pops up and down over time. Most traditional surgical authorities contend it is a questionable practice in foot surgery, and in this case the HPC has determined it should not be performed by an individual who has not been fully trained and accredited in open surgery. Others say it has a role, and it is indeed a separate alternative to open surgery that it can be learnt through a separate pathway. This similarity exists in dentistry with max/fax vs 'implant surgery' devotees.

I think there is some evidence to support at least a few MIS procedures (eg percutaneous TAL in diabetes comes to mind). Generally, like a lot of surgery - the evidence base is pretty thin.

Has the time not come to produce graduates from our universities who can do more than remove a nail edge and do chemical matrixectomy, or currettage a wart? It has been decades since these procedures were first introduced into undergraduate curriculums around the Commonwealth..but we have not moved forward from here.

Worth some debate - considering the GP down the corridor from me is "allowed" to perform a wider array of minor foot surgery than I am allowed to.

LL

NewsBot · Feb 27, 2009

Here is the news media take on this story:
Foot specialist banned from operating

A PODIATRIST who advertised expertise in keyhole surgery when he had only practised on corpses has been banned from operating for three years.
A Fitness to Practise hearing before the Health Professions Council was told Amin Sain, 36, had carried out keyhole surgery on dead bodies for less than 26 days before advertising his West Bridgford practice in the Yellow Pages in 2003.
Sain also claimed he was the UK Director of the General Podiatric Surgery Council, a body unknown to the council. The hearing decided he could continue to work as a podiatrist provided he did not operate.
Giving the verdict yesterday, Ian Griffiths, chairman of the HPC panel, said Sain's actions were so serious a Conditions of Practice order was necessary.
"The British public have the right to expect that any healthcare professional who performs surgery has been trained to a safe standard," he said. "However, Mr Sain lacks the full underpinning surgical knowledge to perform MIS (keyhole surgery) safely."
Sain admitted practicing MIS but said he had the appropriate expertise. He denied his fitness to practise was impaired.
"It was an extension to what I was already doing," he said.
Sain also denied describing himself as director of the General Podiatric Surgery Council but this was upheld by the tribunal.
Click to expand...

Link

joseph Paterson · Mar 3, 2009

NewsBot said: ↑

Here is the HPC decisions:
Link
Click to expand...

Having read the judgement I did notice that Mr Sain can still carry on working, I was wondering how others felt who maybe in thier opion they have been struck off for in thier own opion less serious behavoour.

Perhaps is if he wore a bondage outfit during surgery the outcome may have been different.:wacko:

Joseph

Cameron · Mar 4, 2009

netizens

The case aside these are two interesting statments taken from the HPC summary report.

>Further, although mention has been made of the SCP training programmes, neither the old nor the new has been an approved course in the sense in which the HPC approves courses, the passing of which automatically qualifies for registration.

>The Panel finds that the British public have the right to expect that any healthcare professional who performs surgery (of any type) has been trained to a safe and quantifiable standard. There is no proscribed route in Podiatry to obtain such a standard in the UK, but the most usual method is following the SCP route already identified. This is the course of training and examination that is recognised by the N.H.S. and various private healthcare providers.

In light of their content should we not expect the HPC in the interests of the British Public and the scope of practice of podiatry now call to register the practice of surgical podiatry in the UK?

Consider the blue touch paper lit.:dizzy:

What say you?
toeslayer

W J Liggins · Mar 5, 2009

Whether a move is made to to register the practice of podiatric surgery is, I suspect, in the hands of the Department of Health. But please God, not "surgical podiatry" We have consultant podiatric surgeons in the NHS but not "surgical podiatrists"!

Bill Liggins

rosherville · Mar 5, 2009

Hi Toeslayer,

You make some interesting points. Considering:

1. 'Podiatric Surgeon” is not a protected title in the way that “Podiatrist” is undoubtedly protected by the HPC. Further, although mention has been made of the SCP training programmes, neither the old nor the new has been an approved course in the sense in which the HPC approves courses, the passing of which automatically qualifies for registration'.

2. 'The Panel has no mandate to embark on some general review of training in Podiatric Surgery',

This possibly leaves many Podiatric Surgeons, where....?

The course leading to Fellowship of the Podiatry Association was, however, approved and recognised by the CPSM and hence by Privy Council; under the HPC Order 2001 any qualification in the register maintained under the 1960 CPSM Act would continue to have validity but no new registrants could be added if the HPC wanted to have nothing to do with that aspect ! That is what they have done.

So if you`re an FPodA you`re ok, if not......... don`t end up in court being cross examined as to the validity of your qualification !

In 20 years most FPodA`s will probably have retired and foot surgery will be all back with the orthopods !

Nottingham foot specialist 'lied about knowledge'

NewsBot The Admin that posts the news.

Craig Payne Moderator

DAVOhorn Well-Known Member

joseph Paterson Active Member

William Fowler Active Member

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

Craig Payne Moderator

LuckyLisfranc Well-Known Member

NewsBot The Admin that posts the news.

joseph Paterson Active Member

Cameron Well-Known Member

W J Liggins Well-Known Member

rosherville Active Member

Podiatrist needed in Nottingham

Job opportunity in the Nottingham area

Senior podiatrist needed in Shuropody Nottingham

Fancy a new challenge in Nottinghamshire / Derbyshire?

Nottingham - Podiatrist required for maternity cover

Full Time Podiatrist Job Nottinghamshire

Tactile function of the foot in children with upper motor neuron lesions

Share This Page

Nottingham foot specialist 'lied about knowledge'

NewsBot The Admin that posts the news.

Craig Payne Moderator

DAVOhorn Well-Known Member

joseph Paterson Active Member

William Fowler Active Member

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

Craig Payne Moderator

LuckyLisfranc Well-Known Member

NewsBot The Admin that posts the news.

joseph Paterson Active Member

Cameron Well-Known Member

W J Liggins Well-Known Member

rosherville Active Member

Podiatrist needed in Nottingham

Job opportunity in the Nottingham area

Senior podiatrist needed in Shuropody Nottingham

Fancy a new challenge in Nottinghamshire / Derbyshire?

Nottingham - Podiatrist required for maternity cover

Full Time Podiatrist Job Nottinghamshire

Tactile function of the foot in children with upper motor neuron lesions

Share This Page

Useful Searches