In the December edition of stroke http://bit.ly/h21GuE Dr. Asplund from Riks-Stroke, Department of Medicine, University Hospital, Umeå, Sweden looks at Patient Dissatisfaction With Acute Stroke Care. The group highlight the potential for reducing patient dissatisfaction by structural measures, such as access to care in a stroke unit, patient involvement in discharge planning, and systematic follow-up after discharge.
However the strongest predictor of dissatisfaction with acute care was poor functional outcome. If the patient is dependent on caregivers for daily living this leads to a depressed mood state and poor self-perceived health.
Our experiences with the HandTutor system in the community setting show that providing the patient with an ergonomic glove and easy to use rehabilitation software motivates both the patient and their caregiver to do intensive exercise practice. The home care therapy sessions can be supported by physical and occupational therapists offering tele-rehabilitation which again gives the patient the feeling that the patient and care giver are not alone and there is still progress to be made in their physical rehabilitation.
Sunday 26 December 2010
HandTutor system provides intensive repetition exercises and is a clinical and economically proven tool
In the December edition of Topics in Stroke Rehabilitation Dr. Backus and her team from Shepherd Center, Atlanta, Georgia USA comment on Translating Research Into Clinical Practice: Integrating Robotics Into Neurorehabilitation for Stroke Survivors http://bit.ly/hZJJrP
The report states that robotic devices hold the promise of providing high doses of repetitive movement in a reliable and controllable manner and are causing both excitement and apprehension among therapists and rehabilitation clinic management.
The group concludes that the role that robotic devices play in the continuum of clinical care remains uncertain.
Are robotic devices a status symbol that says: “we are a top rehabilitation center”, “I am a top therapist”, “our clinic offer patients the most up to date treatment options”. Alternatively are they clinically and economically proven and more effective than traditional intensive therapy.
The HandTutor system offers therapists and clinic managers a cost effective tool that provides patients with intensive active exercise practice with proven hand movement rehabilitation outcome.
The report states that robotic devices hold the promise of providing high doses of repetitive movement in a reliable and controllable manner and are causing both excitement and apprehension among therapists and rehabilitation clinic management.
The group concludes that the role that robotic devices play in the continuum of clinical care remains uncertain.
Are robotic devices a status symbol that says: “we are a top rehabilitation center”, “I am a top therapist”, “our clinic offer patients the most up to date treatment options”. Alternatively are they clinically and economically proven and more effective than traditional intensive therapy.
The HandTutor system offers therapists and clinic managers a cost effective tool that provides patients with intensive active exercise practice with proven hand movement rehabilitation outcome.
Are retrospective studies powerful enough to draw conclusions on functional outcome in stroke
In a Retrospective study published in Circulation and the Journal of the American Heart Association Dr. Kurth from INSERM in Paris France show that migraines are associated with increased risk of ischemic stroke however these strokes are typically associated with good functional outcomes. See more details: http://bit.ly/eYu0KI
Passing thought: Is a retrospective study powerful enough to draw conclusions on functional outcome in stroke when there are so many independent variables including treatment protocols, assessment tools to name just two?
Passing thought: Is a retrospective study powerful enough to draw conclusions on functional outcome in stroke when there are so many independent variables including treatment protocols, assessment tools to name just two?
Virtual functional tasks meet therapy goals of intensive exercise
In the December edition of study published in Topics in Stroke Rehabilitation Dr. Flynn and her group discuss the “Development of an Interactive Game-Based Rehabilitation Tool for Dynamic Balance”. The group tested commercially available gaming systems and found that current commercial games are not compatible with controlled, specific exercise required to meet therapy goals http://bit.ly/dYbkxH
Is this finding all so due to the sensors being used in commercially available games only testing to see that the end point of the movement has been reached and therefore do not prevent compensatory movement strategies?
MediTouch have developed the LegTutor system that allows for the implementation of virtual functional lower extremity tasks. The system incorporates 3D position information on the hip and allows the patient to practice intensive isolated knee and hip exercises. Using the LegTutor system in combination with traditional functional exercises promotes functional rehabilitation.
Is this finding all so due to the sensors being used in commercially available games only testing to see that the end point of the movement has been reached and therefore do not prevent compensatory movement strategies?
MediTouch have developed the LegTutor system that allows for the implementation of virtual functional lower extremity tasks. The system incorporates 3D position information on the hip and allows the patient to practice intensive isolated knee and hip exercises. Using the LegTutor system in combination with traditional functional exercises promotes functional rehabilitation.
Too much tone to do traditional task practice then start virtual functional practice with HandTutor
The Journal of Rehabilitation Medicine reports on an upcoming double-blind, prospective, randomized, European and Canadian study: Evaluating patient outcomes and costs of managing adults with post-stroke focal spasticity http://bit.ly/gOMxLq
The trial to be conducted by Division of Rehabilitation Medicine; Department of Clinical Sciences Karolinska Institutet; Sweden led by Dr. Borg is aiming to provide evidence for the extended use of botulinum toxin A in focal post-stroke upper and lower limb spasticity and to evaluate the impact of incorporating botulinum toxin treatment into the rehabilitation of patients with spasticity.
Occupational and Physical therapists can reduce the patient’s spasticity level during training. It is important that during this training the patient undertakes repetitive customized exercises that improve their sensory and motor movement ability. The HandTutor system provides virtual functional task practice exercises that motivates and allows the patient to exercise even if they have limited movement ability. This limited movement ability prevents the patient from doing traditional task practice exercises. Intensive repetitive exercises using the HandTutor, therefore improves the patients functional recovery.
The trial to be conducted by Division of Rehabilitation Medicine; Department of Clinical Sciences Karolinska Institutet; Sweden led by Dr. Borg is aiming to provide evidence for the extended use of botulinum toxin A in focal post-stroke upper and lower limb spasticity and to evaluate the impact of incorporating botulinum toxin treatment into the rehabilitation of patients with spasticity.
Occupational and Physical therapists can reduce the patient’s spasticity level during training. It is important that during this training the patient undertakes repetitive customized exercises that improve their sensory and motor movement ability. The HandTutor system provides virtual functional task practice exercises that motivates and allows the patient to exercise even if they have limited movement ability. This limited movement ability prevents the patient from doing traditional task practice exercises. Intensive repetitive exercises using the HandTutor, therefore improves the patients functional recovery.
HandTutor tele-rehabilitation system
In a recent article in Rehabilitation Engineering, Dr Colombo and his team from Rehabilitation Institute Veruno and Pavia Italy discuss the development of systems architecture for robot aided tele-rehabilitation http://bit.ly/gZ2AFQ
The group note that to date, previous tele-rehabilitation studies have NOT studied a modular combination of rehabilitation devices that can be used by patients with a wide range of different ages, education, technology background and level of movement ability. Because patient motivation is an important factor in rehabilitation outcome a tele-rehabilitation system needs to increases patient satisfaction and motivation above or equal to that gained with traditional clinic based rehabilitation services. In addition the system needs to increase intensity of patient exercise performance and reduce health care costs. They point out that the technology has to be very user friendly so that the patient and therapist will concentrate on the task and not on the technology. Tele-rehabilitation holds the promise of allowing for improved continuity of care, increased exercise time and continuity of treatment with a reduction in the rehabilitation resources required. Interaction between the therapist and the patient can be through real time concurrent monitoring of the patient doing the virtual rehabilitation task with the patient and therapist being online at the same time during the session. Alternatively, intermittent online therapy consists of the therapist going online to update the exercise task and monitor the patient’s adherence to exercise regimen.
The HandTutor and ArmTutor system consists of a comfortable ergonomic glove and elbow brace with 3D shoulder position feedback. The patient wears the HandTutor and ArmTutor and the system allows the patient to practice multi-joint virtual functional tasks. The tasks are formulated so that they mimic ADL tasks like hair brushing, hand reaching and grasping. Continuous and intermittent online therapy is possible with the HandTutor system as the virtual functional tasks motivate the patient to practice on their own and either the patient or the therapist updating the task. Additionally evaluations on the patient’s quality, accuracy, speed of movement are incorporated into the HandTutor system allowing the therapist to quantitatively monitor the patient’s progress.
The group note that to date, previous tele-rehabilitation studies have NOT studied a modular combination of rehabilitation devices that can be used by patients with a wide range of different ages, education, technology background and level of movement ability. Because patient motivation is an important factor in rehabilitation outcome a tele-rehabilitation system needs to increases patient satisfaction and motivation above or equal to that gained with traditional clinic based rehabilitation services. In addition the system needs to increase intensity of patient exercise performance and reduce health care costs. They point out that the technology has to be very user friendly so that the patient and therapist will concentrate on the task and not on the technology. Tele-rehabilitation holds the promise of allowing for improved continuity of care, increased exercise time and continuity of treatment with a reduction in the rehabilitation resources required. Interaction between the therapist and the patient can be through real time concurrent monitoring of the patient doing the virtual rehabilitation task with the patient and therapist being online at the same time during the session. Alternatively, intermittent online therapy consists of the therapist going online to update the exercise task and monitor the patient’s adherence to exercise regimen.
The HandTutor and ArmTutor system consists of a comfortable ergonomic glove and elbow brace with 3D shoulder position feedback. The patient wears the HandTutor and ArmTutor and the system allows the patient to practice multi-joint virtual functional tasks. The tasks are formulated so that they mimic ADL tasks like hair brushing, hand reaching and grasping. Continuous and intermittent online therapy is possible with the HandTutor system as the virtual functional tasks motivate the patient to practice on their own and either the patient or the therapist updating the task. Additionally evaluations on the patient’s quality, accuracy, speed of movement are incorporated into the HandTutor system allowing the therapist to quantitatively monitor the patient’s progress.
Motivating early mobilization improves functional ability
In the December edition of Stroke http://bit.ly/hYnXS6 Dr Cumming and his group from University; and School of Physiotherapy La Trobe University, Melbourne, Australia and Department of Medicine University of Melbourne report on a clinical trial to show the effectiveness of Very Early Mobilization After Stroke Fast-Tracks Return to Walking. The group show that very early and intensive mobilization allowed patients to return to walking significantly faster than did standard stroke unit care controls. The LegTutor is a Knee brace and 3D hip position system that allows the patient to perform virtual functional tasks. The LegTutor system allows the patient to practice virtual sitting to standing movement patterns without weight baring. The exercises can also be performed with the therapist assisting the patient to move his legs even if the patient does not have the required range of motion. The LegTutor system therefore allows the patient to perform motivating early mobilization exercises.
Thursday 16 December 2010
The Jury is still out on robotic rehabilitation devices
In the December edition of Topics in Stroke Rehabilitation Dr. Backus and her team from Shepherd Center, Atlanta, Georgia USA comment on Translating Research Into Clinical Practice: Integrating Robotics Into Neurorehabilitation for Stroke Survivors http://bit.ly/hZJJrP
The report states that robotic devices hold the promise of providing high doses of repetitive movement in a reliable and controllable manner and are causing both excitement and apprehension among therapists and rehabilitation clinic management. The group concludes that the role that robotic devices play in the continuum of clinical care remains uncertain.
Are robotic devices a status symbol that says: “we are a top rehabilitation center”, “I am a top therapist”, “our clinic offer patients the most up to date treatment options”. Alternatively is there use clinically proven to be more effective than traditional intensive therapy and also economically justified.
The HandTutor system offers therapists and clinic managers a cost effective tool that provides patients with intensive active exercise practice with proven hand movement rehabilitation outcome.
The report states that robotic devices hold the promise of providing high doses of repetitive movement in a reliable and controllable manner and are causing both excitement and apprehension among therapists and rehabilitation clinic management. The group concludes that the role that robotic devices play in the continuum of clinical care remains uncertain.
Are robotic devices a status symbol that says: “we are a top rehabilitation center”, “I am a top therapist”, “our clinic offer patients the most up to date treatment options”. Alternatively is there use clinically proven to be more effective than traditional intensive therapy and also economically justified.
The HandTutor system offers therapists and clinic managers a cost effective tool that provides patients with intensive active exercise practice with proven hand movement rehabilitation outcome.
Keeping the home care patient motivated to do intensive exercise practice
In the December edition of stroke http://bit.ly/h21GuE Dr. Asplund from Riks-Stroke, Department of Medicine, University Hospital, Umeå, Sweden looks at Patient Dissatisfaction With Acute Stroke Care. The group highlight the potential for reducing patient dissatisfaction by structural measures, such as access to care in a stroke unit, patient involvement in discharge planning, and systematic follow-up after discharge.
However the strongest predictor of dissatisfaction with acute care was poor functional outcome. IF the patient is dependent on caregivers for daily living this leads to a depressed mood state and poor self-perceived health.
Our experiences with the HandTutor system in the community setting show that providing the patient with an ergonomic glove and easy to use rehabilitation software motivates both the patient and their caregiver to do intensive exercise practice. The home care therapy sessions can be supported by physical and occupational therapists offering tele-rehabilitation which again gives the patient the feeling that the patient and care giver are not alone and there is still progress to be made in their physical rehabilitation.
However the strongest predictor of dissatisfaction with acute care was poor functional outcome. IF the patient is dependent on caregivers for daily living this leads to a depressed mood state and poor self-perceived health.
Our experiences with the HandTutor system in the community setting show that providing the patient with an ergonomic glove and easy to use rehabilitation software motivates both the patient and their caregiver to do intensive exercise practice. The home care therapy sessions can be supported by physical and occupational therapists offering tele-rehabilitation which again gives the patient the feeling that the patient and care giver are not alone and there is still progress to be made in their physical rehabilitation.
Wednesday 15 December 2010
Signs and symptoms to predict movement ability outcome
In the December edition of PM&R Dr. Ramasamya and his UK group from the Academic Department of Military Surgery and Trauma, Birmingham and colleagues from Royal National Orthopaedic Hospital, Stanmore, University Hospital, Middlesborough and Defence Medical Rehabilitation Centre discuss Peripheral nerve injury following combat extremity trauma—does plantar sensation return? The report can be found at http://bit.ly/hB7oHK.
They conclude that as 95% of salvaged limbs with a documented insensate foot at initial presentation showed a return of plantar sensation then initial plantar sensation is not prognostic of long-term plantar sensory status and should not be a component of a limb-salvage decision algorithm.
Therapists and doctors should focus on signs and symptoms rather than initial diagnosis as an outcome prediction. The HandTutor system can be used for all patients that have hand movement dysfunction regardless of diagnosis. The system focuses on the sign and symptoms which are the amount and quality of patient’s active movement ability. This information provides the therapist and patient with real time feedback on movement ability and improvement.
They conclude that as 95% of salvaged limbs with a documented insensate foot at initial presentation showed a return of plantar sensation then initial plantar sensation is not prognostic of long-term plantar sensory status and should not be a component of a limb-salvage decision algorithm.
Therapists and doctors should focus on signs and symptoms rather than initial diagnosis as an outcome prediction. The HandTutor system can be used for all patients that have hand movement dysfunction regardless of diagnosis. The system focuses on the sign and symptoms which are the amount and quality of patient’s active movement ability. This information provides the therapist and patient with real time feedback on movement ability and improvement.
Shortage of trained PT's projected
In the December edition of PM&R DR. Zimbelman and her team from Cleveland Medical Centre USA look at Physical Therapy Workforce in the United States: Forecasting Nationwide Shortages http://bit.ly/hTf5ax . The group reports that On the basis of current trends, demand for PT services will outpace the supply of PTs within the United States.
In regards to neuromuscular rehabilitation, industry has to further develop intense and engaging upper-extremity rehabilitation tools that motivate the patient to intensively practice therapy tasks with less dependence of the therapist. The increased use cost-effective systems that can be used by the patient alone or with caregiver support will reduce the demand on PT’s, the healthcare system and healthcare budget.
The HandTutor system is used by patients in the home care environment with quantitative exercise performance data being stored so that it can be reviewed by the therapist. In addition the therapist can take part in the patients treatment from a remote location by using readily available web based tools.
In regards to neuromuscular rehabilitation, industry has to further develop intense and engaging upper-extremity rehabilitation tools that motivate the patient to intensively practice therapy tasks with less dependence of the therapist. The increased use cost-effective systems that can be used by the patient alone or with caregiver support will reduce the demand on PT’s, the healthcare system and healthcare budget.
The HandTutor system is used by patients in the home care environment with quantitative exercise performance data being stored so that it can be reviewed by the therapist. In addition the therapist can take part in the patients treatment from a remote location by using readily available web based tools.
Tuesday 14 December 2010
An informative open access article that discusses poor motor skill ability and ADHD found at: http://bit.ly/fyjpAk
The paper quotes references to support:
1. Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders, affecting approximately 3-9% of all school-aged children.
2. ADHD is characterized by a chronic developmentally inappropriate pattern of hyperactivity, inattention and impulsivity, which impairs academic performance, social interaction, and family function.
3. A high percentage of children with ADHD (30-50%) continuing to experience symptoms into adulthood.
4. Poor motor performance skills, are prevalent in children with ADHD, characterized by: excessive overflow movements, poor timing, force control, balance leading to poor ADL ability; e.g. tying shoes, poor handwriting, etc.
5. 50% of children with ADHD display motor coordination problems consistent with developmental coordination disorder (DCD).
6. The typical feature of DCD involves a marked impairment in the performance of motor skills that is not due to general intellectual, sensory, or motor neurological impairment. www.HandTutor.com
The paper quotes references to support:
1. Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental disorders, affecting approximately 3-9% of all school-aged children.
2. ADHD is characterized by a chronic developmentally inappropriate pattern of hyperactivity, inattention and impulsivity, which impairs academic performance, social interaction, and family function.
3. A high percentage of children with ADHD (30-50%) continuing to experience symptoms into adulthood.
4. Poor motor performance skills, are prevalent in children with ADHD, characterized by: excessive overflow movements, poor timing, force control, balance leading to poor ADL ability; e.g. tying shoes, poor handwriting, etc.
5. 50% of children with ADHD display motor coordination problems consistent with developmental coordination disorder (DCD).
6. The typical feature of DCD involves a marked impairment in the performance of motor skills that is not due to general intellectual, sensory, or motor neurological impairment. www.HandTutor.com
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