International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 88 Diagnosing Ankle Diseases Expert System Sabreen R. Qwaider , Department of Information Technology Faculty of Engineering & Information Technology, Al-Azhar University, Gaza, Palestine Abstract: In recent years, technology has evolved significantly to intervene in the treatment of diseases through diagnosis online before going to the specialist doctor, where it become possible for the patient to know the name of his illness, the specialist doctor who can treat him and the multiple treatment methods through specially designed systems called expert systems. The expert system is based on the principle of asking the user gradual questions about the symptoms he feels, leading him to the result of diagnosing the illness, dealing with it quickly, and tips for permanent treatment. These systems may also help both trainee physicians and physiotherapists. This research paper is a living example of these effective applications, explaining in a simplified manner some of ankle diseases, how to deal with them and methods of physical therapy. The ankle is a small region in the leg. It is two joints, the first consist of three bones (tibia, fibula and talus underneath) which is called true ankle joint. The other is called subtalar joint have two bones: talus on top and calcaneus on the bottom. This tarsus between the end of the leg and the start of the foot facilitates the movement up-down and left-right with no problems in normal case, although, it needs a special case as Physiotherapist when gets injury. We have identified seven ankle diseases: Ankle Sprain, Fracture (of Fibula), Rheumatoid Arthritis, Rheumatoid Fever, Gout, and Osteoarthritis (Degenerative Joint) using SL5 Object Expert System Language in the work of the expert system. Keywords: Sprained ankle, ankle bones, ankle pain, expert system with applications, knowledge management, knowledge base tools, and knowledge based System 1. INTRODUCTION The term Ankle represents the region of meeting between the leg and the foot. It is the point where bear the full weight of the human body. In medical terminology, ankle can refer broadly to the region to the talocrural joint [1]. As you can see at the picture below, the bones, which form the ankle, are (in the foot) talus is a foot bone sits above the heel bone, and (in the leg) tibia is the shinbone and fibula the thinner bone next to the shinbone [1, 2]. Side by side, the ligaments that strongly joint the bones together and allow the movement of the leg easily are four:  Deltoid ligment: is a strong, flat, triangle band, which is composed of the anterior tibiotalar ligament, tibiocalcaneal ligament, posterior tibiotalar ligament and the tibionavicular ligament [3].  The anterior talofibular ligament.  The posterior talofibular ligament.  The calcaneofibular ligament. Figure 1: Ankle graphic photo for the bone and ligaments ‎[22] International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 89 From the above abstract details which describe the importance of the ankle, if one from those bones, joints or ligaments are damaged or suffered minor damage, that will cause pain and a true problem‎if‎it‎doesn't‎treat‎well.‎ From these disease are: Fracture, severe sprain, sprained ankle, Fracture of the fibula, Rheumatoid arthritis, Rheumatoid fever, Infected joint, Gout, Osteoarthritis, or Degenerative joint. Until these days, there are no specialized doctors at ankle or foot problems [4], although the cases are patronized by Orthopedist hand‎by‎hand‎with‎Physiotherapist.‎As‎computer‎programmer‎specialists,‎we‎seek‎to‎integrate‎technology‎with‎field's‎life‎to‎have an easy more healthy living.‎ In‎ this‎manner,‎ we‎ develop‎ an‎ expert‎ system‎ for‎ diagnosing‎ ankle's‎ injuries‎ based‎ on‎ ask‎ reasoning‎ questions to guide you to the main problem. In addition, this application will help junior doctors on recognition the problems. 2. KNOWLEDGE-BASED SYSTEM: Knowledge-based System -KBS- (or Expert System) is a computer system that emulated the decision-making ability of a human expert in a restricted domain [5,37-40]. The aim of the expert system is solve the problem by using the information provided by the end-user and processing it inside the application by if-conditions to obtain the result as new knowledge presented again to the user. Many successful expert applications prove the validity of using technology in other fields like: Dendral (at chemical), Mycin (at medicine), Prospector (at geology) and Decision support system (at Business) [6,7]. Each one of these applications consists of main components as expert system, which described in details at the following: Figure 2: Knowledge Based System Structure ‎[7]  User Interface (UI): to facilitate exchanging the information and the facts between the user and the Inference engine.  Inference Engine: mechanism to derive new knowledge from existing knowledge and information provided by the user, also,‎it‎contain‎"Agenda"‎to‎locate‎a‎goal‎and‎specific‎rules‎used‎to‎acquire‎new‎knowledge.  Knowledge Based: contains whole rules and facts about a certain domain provided either directly from the environment or from the expert person (developer).  Working Memory: Which store temporary information that entered from the end-user. 3. MATERIAL AND METHOD: The tendered expert system diagnoses seven ankle diseases between fractures, sprain, types of arthritis, and joint problems. It depends on asking the patient a related yes/no questions about the symptoms felt by the injured. After the system finishes asking, it will show the diagnoses (the name of the illness) with recommendation and quick self-care. The following figures show the program interfaces for the main page, symptoms question page and diagnosis and recommendation page. International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 90 Figure 3: Main Expert System Interface Figure 4: Yes/NO Question Screen Figure 5: Diagnosis and Recommendation Screen International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 91 4. BACKGROUND/LITERATURE REVIEW: Expert Systems are a good decision-maker when there is a good knowledge existing inside it. The knowledge comes from the environment, expert person, and client feedback, too, which make it in a constant evolution to get client satisfaction. Nowadays, there is a lot of knowledge-based system that treats a special problem or manages a certain domain; however, the most useful is system, which diagnosis patient diseases and give initial processing order, such as treating diseases in: infants and children, ear problems, low back pain, neck pain, foot and even breast cancer illness [4, 31-31-60]. Although there is no free, available expert system‎to‎help‎dealing‎with‎"Ankle‎Problems"‎in‎the‎right‎way,‎which‎provides‎in‎this‎paper. 5. KNOWLEDGE REPRESENTATION: The major‎source‎of‎recognition‎disease's‎data‎is‎form‎Podiatric‎physician‎and‎specializes‎websites‎[2,‎8]. The information has transformed to SL5 Object Expert System Language by syntax (rules, facts, and objects)[39]. Currently the application has converted seven diseases by eight Attributes and fifteen rules. Ankle Fracture or Broken Ankle: It‎ refers‎ to‎ broken‎ at‎ one‎ of‎ the‎ ankle‎ joint‎ bones,‎which‎may‎be‎Simple‎ break‎ in‎ one‎ bone,‎ such‎ it‎ doesn't‎ stop‎ you‎ from‎ walking, or several fractures, which compelling you to be at bed for weeks. It may be caused by twisting or rolling the ankle, drop down the stairs, or being in an accident. Although the main problem is that, the fracture cannot be diagnosis rather than sprain of the ankle a dislocation, or tendon injury without X-rays [9,10]. The next picture demonstrates the break position: Figure 6: Ankle Fracture Fracture of the Fibula: It is a break of the small two outside bones. It may be complete or incomplete fracture on any part along of the bone. Although, the special two things of this type of a break are it is common, and almost it accompanied by ankle sprain that make the problem more complex [12]. International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 92 Figure 7: Fracture of the Fibula ‎[27] Ankle Sprain: It refers to stretch or possibly torn of the ligament ankle. It has happened to soccer player when rapid shifting with foot planted [11]. Some states could be treated directly if it is simple and other will make more pain when put weight on the ankle while walking. Figure 8: Ankle Sprain ‎[23]‎[23] Rheumatic Fever: R‎fever‎is‎an‎inflammation‎disease‎developed‎be‎insufficient‎treatment‎to‎strep‎throat‎or‎scarlet‎fever‎that‎attack‎humans'‎body after infection with streptococcus bacteria. The harm of R fever can damage heart valves and heart failure, although, the treatment reduces the pain and prevent its recurrence. [15] International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 93 Figure 9: Rheumatic Fever ‎[29] Rheumatoid Arthritis (RA): It‎is‎an‎autoimmune‎disease‎such‎the‎body's‎immune‎system‎attacking‎mistakenly‎the‎joints.‎The‎immune‎system‎that‎supposed‎ to be the first defense line of any misters enters the body as bacteria or viruses, sudden attack the joints create inflammation, which effect at it and may cause swelling and pain in and around the joints. Even more, if the inflammation does not treat well and quick may‎affect‎the‎body's‎system as cardiovascular or respiratory systems [14]. The following picture evinces the effect of it. This disease must discover early as doctors recommend depending on its fast and severe effect. Figure 10: Rheumatoid Arthritis ‎[28] International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 94 Gout: It is an arthritis caused by form in joint needle-like crystal of uric acid. The normal percent of uric acid in blood does not doing anything, however if the percentage is abnormally getting up to build up crystal compounds in joints, it will cause painful arthritis, blockage of the kidney which lead to kidney failure. Gout is the most frequent recorded medical illness throughout history [16, 17]. Figure 11: Gout illness ‎[30] Osteoarthritis (OA) or Degenerative Joint: Degenerative Arthritis, arthritis, Osteoarthritis, or Degenerative Joint is the same meaning of one illness that is damaged the surface of the joints called cartilage covers the end of each bone, to become the joint movement not smoothly. When OA worsens over time, it may give rise to break down the bone and develop growths called spurs. Bits of bone or cartilage may chip off and float around in the joint [18, 19]. Figure 12: Osteoarthritis (OA) at foot joints ‎[24] International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 95 Figure 13: Degenerative Joint at joint between two bones ‎[25] Figure 14: Health joint and Osteoarthritis at joint ‎[26] 6. DECISION TREE FOR THE KBS ANKLE ILLNESSES DIAGNOSIS: Decision tree is a decision support tool illustrate graph as tree its branches contain every possibility, resource, cost or event related to the subject [13]. Our decision tree, as you can see at Figure3 based its branches on expected symptoms as Yes/No questions. The end-user (patent) answers the first question (the root of the tree), which will transfer him to another question (from the leaves question at the branches of the tree), and continue this operation until get complete information about his status, then shows the result. The result contents are the diagnosis of the symptoms and self-caring as a quick treatment or urgent message to go to the doctor when the state is danger. International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 96 Figure 15: Decision Tree to diagnose ankle diseases by Sabreen Qwaider. 7. SYSTEM EVALUATION: At this preliminary evaluation, my brother Eng. Mohammed Qwaider as Technology Expert, and patients have bruises or trauma at the ankle, have tested this Knowledge based system. They have felt familiar and comfortable with its interfaces, easy usage and simplicity of information. 8. CONCLUSION: This paper demonstrates simply a new expert system to diagnose ankle disease easily by presenting screens to help end user. This knowledge-based system was developed using SL5 Expert System Language, will help both Podiatric physician and end user who do not know much about the diseases but have a serious urgent case to do Band Aid. International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 97 The system currently covers the following seven illnesses for ankle pain: Ankle Fracture, Fracture of fibula, Ankle Sprain, Rheumatoid Arthritis, Rheumatic Fever, Gout, and Osteoarthritis. 9. FUTURE WORK: This application is expected to be more intuitive and useful as part of an integrated expert system that contains a diagnosis of whole the anticipated problems in the body parts from head to foot. 10. EXPERT SYSTEM SOURCE CODE: ! A Knowledge Based System for Ankle Diagnosis ! Written By: Sabreen R. Qwaider ! Supervised By: Samy Abu Naser ATTRIBUTE Did you begin to have pain or swelling after a twisting or hit on the ankle COMPOUND Yes, No ATTRIBUTE Is there significant swelling and the pain so intense you are unable to walk COMPOUND Yes, No ATTRIBUTE Is there swelling and a bruise but you are still able to walk on the ankle COMPOUND Yes, No ATTRIBUTE Do you have swelling or stiffness or pain that comes and goes in both ankles COMPOUND Yes, No ATTRIBUTE Do you have a fever or is more than one joint swollen and red COMPOUND Yes, No ATTRIBUTE Did the pain come on suddenly or through rub bedding with joint COMPOUND Yes, No ATTRIBUTE Do you feel pain or suffer swelling during a change in the weather or using the ankle COMPOUND Yes, No ATTRIBUTE start SIMPLE INSTANCE the domain ISA domain WITH start := TRUE INSTANCE the application ISA application WITH title display := introduction WITH conclusion display := Conc WITH compound query text := " * of *" INSTANCE introduction ISA display WITH wait := TRUE WITH delay changes := FALSE WITH items [1 ] := textbox 1 INSTANCE textbox 1 ISA textbox WITH location := 10,10,800,350 WITH pen color := 255,255,255 WITH fill color := 000,000,255 WITH justify IS left WITH font := "Arial" WITH font style IS bold WITH font size := 14 WITH text :=" Ankle Illness Diagnosis Expert System Written By: Sabreen R. Qwaider - Supervised By: Prof. Samy S. Abu Naser - This Expert system is a practical application of Simpler Level 5 Object (SL5 Object) that demonstrate the use of some of the system classes, instances, rules, etc. This Knowledge-based system diagnoses Ankle Diseases through a dialogue between the System and End-User. The Conclusion of the finding is displayed and a recommend is given for the End User to diagnosis the Diseases. " International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 98 INSTANCE Conc ISA display WITH wait := TRUE WITH delay changes := FALSE WITH items [1] := title textbox WITH items [2 ] := diagnosis textbox WITH items [3 ] := recommend textbox INSTANCE title textbox ISA textbox WITH location := 20,10,800,70 WITH pen color := 255,255,255 WITH fill color := 255,000,000 WITH justify IS center WITH font := "Arial" WITH font style IS bold WITH font size := 14 WITH text := " The Conclusion of the Ankle Diagnosis Expert System " INSTANCE diagnosis textbox ISA textbox WITH location := 20,110,800,130 WITH pen color := 0,0,0 WITH fill color := 255,255,255 WITH justify IS left WITH font := "Arial" WITH font style IS bold WITH font size := 12 WITH text :=" --===--" INSTANCE recommend textbox ISA textbox WITH location := 20,280,800,130 WITH pen color := 0,0,0 WITH fill color := 255,255,255 WITH justify IS left WITH font := "Arial" WITH font style IS bold WITH font size := 12 WITH text :=" --===--" RULE R0 IF start THEN ASK Did you begin to have pain or swelling after a twisting or hit on the ankle RULE R1 IF Did you begin to have pain or swelling after a twisting or hit on the ankle IS Yes THEN ASK Is there significant swelling and the pain so intense you are unable to walk RULE R1a IF Did you begin to have pain or swelling after a twisting or hit on the ankle IS No THEN ASK Do you have swelling or stiffness or pain that comes and goes in both ankles RULE R2 IF Is there significant swelling and the pain so intense you are unable to walk IS Yes THEN text OF diagnosis textbox := " You may have a FRACTURE or a severe SPRAIN. " AND text OF recommend textbox := " Don't walk on the injured foot. Raise the leg and place ice on the swollen area. See your doctor promptly. " International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 99 RULE R2a IF Is there significant swelling and the pain so intense you are unable to walk IS No THEN ASK Is there swelling and a bruise but you are still able to walk on the ankle RULE R3 IF Is there swelling and a bruise but you are still able to walk on the ankle IS Yes THEN text OF diagnosis textbox := " You may have a SPRAINED ANKLE or a FRACTURE of the FIBULA. " AND text OF recommend textbox := " Use ice, elevation, rest and an elastic bandage to keep the swelling under control. See your doctor if the swelling and pain continue. " RULE R3a IF Is there swelling and a bruise but you are still able to walk on the ankle IS No THEN ASK Do you have swelling or stiffness or pain that comes and goes in both ankles RULE R4 IF Do you have swelling or stiffness or pain that comes and goes in both ankles IS Yes THEN text OF diagnosis textbox := " You may have RHEUMATOID ARTHRITIS. " AND text OF recommend textbox := " See your doctor. He or she can prescribe medicine to help control the symptoms of rheumatoid arthritis. " RULE R4a IF Do you have swelling or stiffness or pain that comes and goes in both ankles IS No THEN ASK Do you have a fever or is more than one joint swollen and red RULE R5 IF Do you have a fever or is more than one joint swollen and red IS Yes THEN text OF diagnosis textbox := " Fever along with a painful, swollen joint could be caused by an INFECTED JOINT. More than one affected joint could mean RHEUMATIC FEVER. " AND text OF recommend textbox := " URGENT SEE YOUR DOCTOR RIGHT AWAY. " RULE R5a IF Do you have a fever or is more than one joint swollen and red IS No THEN ASK Did the pain come on suddenly or through rub bedding with joint RULE R6 IF Did the pain come on suddenly or through rub bedding with joint IS Yes THEN text OF diagnosis textbox := " You may have GOUT (inflammation caused by high uric acid level in the blood). " AND text OF recommend textbox := " See your doctor. During a gout attack, you should rest in bed. You can put a hot pad or an ice pack on your ankle to ease the pain. " RULE R6a IF Did the pain come on suddenly or through rub bedding with joint IS No THEN ASK Do you feel pain or suffer swelling during a change in the weather or using the ankle RULE R7 IF Do you feel pain or suffer swelling during a change in the weather or using the ankle IS Yes International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 100 THEN text OF diagnosis textbox := " These symptoms could be caused by OSTEOARTHRITIS, also called DEGENERATIVE JOINT DISEASE, or by previous trauma to the ankle. " AND text OF recommend textbox := " Use heat and an anti-inflammatory medicine to relieve discomfort. See your doctor. " RULE R7a IF Do you feel pain or suffer swelling during a change in the weather or using the ankle IS No THEN text OF diagnosis textbox := " For more information, please talk to your doctor. " AND text OF recommend textbox := " If you think your problem is serious, call right away. " END REFERENCES 1. Bakeer, H. and S. S. Abu Naser (2017). "Photo Copier Maintenance Expert System V. 01 Using SL5 Object Language." International Journal of Engineering and Information Systems (IJEAIS) 1(4): 116-124. 2. Baker, J., et al. "& Heller, R.(1996)." Information Visualization. Information Technology Journal 7(2). 3. Baker, J., et al. (1996). "Information Visualization." Information Technology Journal 7(2): pp: 403-404. 4. Chen, R.-S., et al. (2008). "Evaluating structural equation models with unobservable variables and measurement error." Information Technology Journal 10(2): 1055-1060. 5. El Agha, M., et al. (2017). "Polymyalgia Rheumatic Expert System." International Journal of Engineering and Information Systems (IJEAIS) 1(4): 125-137. 6. Hissi, H. E.-., et al. (2008). "Medical Informatics: Computer Applications in Health Care and Biomedicine." Journal of Artificial Intelligence 3(4): 78-85. 7. Kashkash, K., et al. (2005). "Expert system methodologies and applications-a decade review from 1995 to 2004." Journal of Artificial Intelligence 1(2): 9-26. 8. Khella, R. and S. S. Abu Naser (2017). "Rule Based System for Chest Pain in Infants and Children." International Journal of Engineering and Information Systems 1(4): 138-148. 9. Li, L., et al. (2011). "Hybrid Quantum-inspired genetic algorithm for extracting association rule in data mining." Information Technology Journal 12(4): 1437-1441. 10. Mrouf, A., et al. (2017). "Knowledge Based System for Long-term Abdominal Pain (Stomach Pain) Diagnosis and Treatment." International Journal of Engineering and Information Systems (IJEAIS) 1(4): 71-88. 11. Nabahin, A., et al. (2017). "Expert System for Hair Loss Diagnosis and Treatment." International Journal of Engineering and Information Systems (IJEAIS) 1(4): 160-169. 12. Abu Naser, S. S. (1993). A methodology for expert systems testing and debugging, North Dakota State University, USA. 13. Abu Naser, S. S. (1999). "Big O Notation for Measuring Expert Systems complexity." Islamic University Journal Gaza 7(1): 57-70. 14. Abu Naser, S. S. (2015). "Sl5 Object: Simpler Level 5 Object Expert System Language." International Journal of Soft Computing, Mathematics and Control (IJSCMC) 4(4): 25-37. 15. Abu Ghali, M. J., et al. (2017). "Expert System for Problems of Teeth and Gums." International Journal of Engineering and Information Systems (IJEAIS) 1(4): 198-206. 16. Abu Naser, S. S. and A. E. A. El-Najjar (2016). "An expert system for nausea and vomiting problems in infants and children." International Journal of Medicine Research 1(2): 114-117. 17. Abu Naser, S. S. and A. O. Mahdi (2016). "A proposed Expert System for Foot Diseases Diagnosis." American Journal of Innovative Research and Applied Sciences 2(4): 155-168. 18. Abu Naser, S. S. and A. Z. A. Ola (2008). "AN EXPERT SYSTEM FOR DIAGNOSING EYE DISEASES USING CLIPS." Journal of Theoretical & Applied Information Technology 4(10). 19. Abu Naser, S. S. and B. G. Bastami (2016). "A proposed rule based system for breasts cancer diagnosis." World Wide Journal of Multidisciplinary Research and Development 2(5): 27-33. 20. Abu Naser, S. S. and I. S. Zaqout (2016). "Knowledge-based systems that determine the appropriate students major: In the faculty of engineering and information technology." World Wide Journal of Multidisciplinary Research and Development 2(10): 26-34. 21. Abu Naser, S. S. and M. A. Hamed (2016). "An Expert System for Mouth Problems in Infants and Children." Journal of Multidisciplinary Engineering Science Studies (JMESS) 2(4): 468-476. 22. Abu Naser, S. S. and M. H. Al-Bayed (2016). "Detecting Health Problems Related to Addiction of Video Game Playing Using an Expert System." World Wide Journal of Multidisciplinary Research and Development 2(9): 7-12. 23. Abu Naser, S. S. and M. I. Alhabbash (2016). "Male Infertility Expert system Diagnoses and Treatment." American Journal of Innovative Research and Applied Sciences 2(4). 24. Abu Naser, S. S. and M. M. Al-Hanjori (2016). "An expert system for men genital problems diagnosis and treatment." International Journal of Medicine Research 1(2): 83-86. 25. Abu Naser, S. S. and M. W. Alawar (2016). "An expert system for feeding problems in infants and children." International Journal of International Journal of Engineering and Information Systems (IJEAIS) ISSN: 2000-000X Vol. 1 Issue 4, June– 2017, Pages: 89-101 www.ijeais.org 101 Medicine Research 1(2): 79-82. 26. Abu Naser, S. S. and M. Z. Shaath (2016). "Expert system urination problems diagnosis." World Wide Journal of Multidisciplinary Research and Development 2(5): 9-19. 27. Abu Naser, S. S. and R. M. AlDahdooh (2016). "Lower Back Pain Expert System Diagnosis and Treatment." Journal of Multidisciplinary Engineering Science Studies (JMESS) 2(4): 441-446. 28. Abu Naser, S. S. and S. H. ALmursheidi (2016). "A Knowledge Based System for Neck Pain Diagnosis." World Wide Journal of Multidisciplinary Research and Development (WWJMRD) 2(4): 12-18. 29. Abu Naser, S. S., et al. (2008). "A Proposed Expert System For Guiding Freshman Students In Selecting A Major In Al-Azhar University, Gaza." Journal of Theoretical & Applied Information Technology 4(9). 30. Abu Naser, S. S., et al. (2016). "Rule Based System for Diagnosing Wireless Connection Problems Using SL5 Object." International Journal of Information Technology and Electrical Engineering 5(6): 26-33. 31. Abu Naser, S., et al. (2010). "Knowledge management in ESMDA: expert system for medical diagnostic assistance." Artificial Intelligence and Machine Learning Journal 10(1): 31-40. 32. AbuEl-Reesh, J. Y. and S. S. Abu Naser (2017). "A Knowledge Based System for Diagnosing Shortness of Breath in Infants and Children." International Journal of Engineering and Information Systems (IJEAIS) 1(4): 102-115. 33. Abu-Naser, S. S. and A. N. Akkila (2008). "A Proposed Expert System for Skin Diseases Diagnosis." Journal of Applied Sciences Research 4(12): 1682-1693. 34. Abu-Naser, S. S., et al. (2010). "An expert system for endocrine diagnosis and treatments using JESS." Journal of Artificial Intelligence; Scialert 3(4): 239-251. 35. Abu-Naser, S. S., et al. (2010). "Developing an expert system for plant disease diagnosis." Journal of Artificial Intelligence ; Scialert 3(4): 269-276. 36. Abu-Naser, S., et al. (1995). "& Beattie, GA (2000)." Expert system methodologies and applications-a decade review from: 9-26. 37. Akkila, A. N. and S. S. Abu Naser (2016). "Proposed Expert System for Calculating Inheritance in Islam." World Wide Journal of Multidisciplinary Research and Development 2(9): 38-48. 38. Al Rekhawi, H. A., et al. (2017). "Rickets Expert System Diagnoses and Treatment." International Journal of Engineering and Information Systems (IJEAIS) 1(4): 149-159. 39. Anderson, J., et al. (2005). "Adaptation of Problem Presentation and Feedback in an Intelligent Mathematics Tutor." Information Technology Journal 5(5): 167-207. 40. Azaab, S., et al. (2000). "A proposed expert system for selecting exploratory factor analysis procedures." Journal of the College of Education 4(2): 9-26. 41. Naser, S. S. A. and H. A. A. Hasanein (2016). "Ear Diseases Diagnosis Expert System Using SL5 Object." World Wide Journal of Multidisciplinary Research and Development 2(4): 41-47. 42. Naser, S. S. A. and M. A. Al-Nakhal (2016). "A Ruled Based System for Ear Problem Diagnosis and Treatment." World Wide Journal of Multidisciplinary Research and Development 2(4): 25-31. 43. Naser, S. S. A. and M. M. Hilles (2016). "An expert system for shoulder problems using CLIPS." World Wide Journal of Multidisciplinary Research and Development 2(5): 1-8. 44. Ng, S., et al. (2010). "Ad hoc networks based on rough set distance learning method." Information Technology Journal 10(9). 45. Sulisel, O., et al. (2005). "Growth and Maturity of Intelligent Tutoring Systems." Information Technology Journal 7(7): 9-37. 46. Almurshidi, S. H. and S. S. Abu Naser (2017). "Design and Development of Diabetes Intelligent Tutoring System." EUROPEAN ACADEMIC RESEARCH 6(9): 8117-8128. 47. Almurshidi, S. H. and S. S. Abu Naser (2017). "Stomach disease intelligent tutoring system." International Journal of Advanced Research and Development 2(1): 26-30. 48. Abu Naser, S. S. (2008). "Developing visualization tool for teaching AI searching algorithms." Information Technology Journal, Scialert 7(2): 350-355. 49. Albatish, I., et al. (2018). "ARDUINO Tutor: An Intelligent Tutoring System for Training on ARDUINO." International Journal of Engineering and Information Systems (IJEAIS) 2(1): 236-245. 50. Aldahdooh, R. and S. S. Abu Naser (2017). "Development and Evaluation of the Oracle Intelligent Tutoring System (OITS)." EUROPEAN ACADEMIC RESEARCH 6(10): 8711-8721. 51. Alhabbash, M. I., et al. (2016). "An Intelligent Tutoring System for Teaching Grammar English Tenses." EUROPEAN ACADEMIC RESEARCH 6(9): 7743-7757. 52. Al-Hanjori, M. M., et al. (2017). "Learning computer networks using intelligent tutoring system." International Journal of Advanced Research and Development(2): 1. 53. El Agha, M. I., et al. (2018). "SQL Tutor for Novice Students." International Journal of Academic Information Systems Research (IJAISR) 2(2): 1-7. 54. Mahdi, A. O., et al. (2016). "An intelligent tutoring system for teaching advanced topics in information security." World Wide Journal of Multidisciplinary Research and Development 2(12): 1-9. 55. Shaath, M. Z., et al. (2017). "Photoshop (CS6) intelligent tutoring system." International Journal of Academic Research and Development 2(1): 81-87.