HandTutor system active exercise to prevent hand and wrist contractures

In the February edition of NeuroRehabilitation http://bit.ly/emURPW Dr. Harvey and her team from Rehabilitation Studies Unit, Northern Clinical School, Sydney School of Medicine, University of Sydney, Australia discuss the management of contractures in Spinal Cord Injury (SCI). Contract ures are a common and disabling problem for people with spinal cord injuries and they are a complex and multifactorial problem to manage. Contractures have largely been managed with physical interventions such as stretch and passive movements and the use of orthotic devices. The objective is to ensure that contractures do not occur by maintaining soft tissue movement.
The HandTutor, ArmTutor and LegTutor systems encourages intensive active exercise practice. The patient is encouraged to flex and extend their fingers, wrist, elbow shoulder, knee and hip joints in order to prevent contractures.

HandTutor system allows for hands on therapy through tele-rehabilitation

In the February issue of Journal of Rehabilitation Medicine http://bit.ly/ev4mth Dr. Nancye M. Peel and her group from Centre for Research in Geriatric Medicine The University of Queensland discuss the implementation of telerehabilitation in older people. The barriers that need to be overcome include patient limitations, staff issues and the logistics of implementing the system. They comment that tele-rehabilitation is challenging because of the complexity of cases, with many requiring “hands-on” therapy.
The HandTutor system uses dedicated rehabilitation software that allows the virtual functional exercise tasks to be tailored to the patients movement ability. The tasks have been designed by physical and occupational therapists and are motivating to a wide range of patients sensory, motor and cognitive ability age and neurological or orthopedic indications.

Rehabilitation outcome in traumatic and non traumatic brain injury

In the February edition of Journal of Rehabilitation Medicine http://bit.ly/ig2zcW Dr. Colantonio and his team from the Toronto Rehabilitation Institute analyze data from the Canadian Institute for Health Information’s National Rehabilitation Reporting System on brain injuries, and inpatient rehabilitation treatment outcome. His group found that approximately half of acquired brain injury patients receiving inpatient rehabilitation had non-traumatic causes of brain injury. Traumatic brain injury patients were more likely to be younger, male, from rural areas, and to make greater gains in rehabilitation. Differences were found in the types and numbers of comorbidities. However, patients from these 2 groups had similar lengths of rehabilitation stay.
The HandTutor, ArmTutor and LegTutor system offer the possibility to do intensive massed and motivated exercise practice and are used in both traumatic and non traumatic brain injury patients.

In the January edition of Neurorehabil Neural Repair http://bit.ly/gEyIUb Dr. Murphy and her group from Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden discuss Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass. In the trial, 19 chronic stroke patients (2 groups moderate and mild Fugl Meyer scores) and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way.

The group looked at kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements. They conclude that patient movement impairments such as range of movement, total movement time, and peak angular velocity of the elbow during the functional task discriminated between the two stroke groups.

The HandTutor and ArmTutor systems encourage intensive exercise practice through virtual functional tasks. The tasks have been designed to exercise individual and combinations of isolated movement parameters. This impaitrment oriented training has been shown to improve functional movement ability. www.HandTutor.com

Customized Motor, Sensory and Cognitive Rehabilitation Improves Functional Gain in Stroke

In the December edition of Neurorehabilitation http://bit.ly/gv6q1R Dr. Cheng and his team from Occupational Therapy Department, MacLehose Medical Rehabilitation Centre, Hong Kong, China confirm that Functional gain in hemorrhagic stroke patients is dependent on the functional level and cognitive abilities measured at hospital admission. The functional ability can be predicted by age, pre-training functional level, and cognitive abilities measured at admission.

The HandTutor system can optimize rehabilitation outcome and functional movement ability by providing motivating virtual functional task practice. www.HandTutor.com

HandTutor eHealth Telemedicine and Tele-Rehabilitation Report

A recent report published by the eHealth Telemedicine community ICT discusses applications in tele-rehabilitation. The report can be found at: http://bit.ly/eeuJgP

The report summarizes tele-rehabilitation as the delivery of rehabilitation services to distant locations, through the use of Information and Communications Technologies (ICT). The report states that the main drive for the introduction of tele-rehabilitation is the need to give specialized therapy to a geographically dispersed population in addition to the need to reduce costs while maintaining or increasing the quality of service. In addition patients that need physically rehabilitation will most probably have mobility issues that make transport to a specialized rehab centre difficult and expensive.

Tele-rehabilitation sessions are more flexible in terms of the timing and frequency of sessions and allow for more follow up on patient compliance and performance when compared to out patient clinic appointments. In addition rehabilitation programs done in the patients home environment have been proven to give better outcomes than equivalent rehabilitation programs conducted in the clinic environment. Up until recently tele-rehabilitation has had two main disadvantages namely, the lack of physical contact between physician and patient and lack of technologies tools that can quantitatively evaluate and treat the patient’s movement dysfunction.

The HandTutor system consists of a glove and software that uses motion feedback sensors to evaluate and treat the patients speed, range and accuracy of hand movements in real time. The dedicated rehabilitation software allows the patient and therapist to monitor and customize the exercise training in real time using readily available remote monitoring and audio and video internet tools to allow for inexpensive virtual physician contact. It is currently being used by patients with hand movement dysfunction in their home environment and is supported by therapists through tele-rehabilitation. http://bit.ly/f6i542

Motor Imagery a rehab method for PD patients

In the January edition of Neurorehabil Neural Repair January Dr. Helsen and her group form Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium study the Motor Imagery Ability in Patients With Early- and Mid-Stage Parkinson Disease. The group found that this practice method can also be successfully applied in the rehabilitation of patients with Parkinson disease (PD).
The HandTutor, ArmTutor and LegTutor system are used to encourage active exercise task practice in Parkinson's PD patients.

HandTutor system effective in upper extremity hemiparesis patients

In the February edition of Neurorehabilitation and Neural Repair http://bit.ly/grWa4B Dr. Whitall and his group from School of Medicine, University of Maryland, Baltimore, Maryland, USA, Baltimore Veterans Affairs Medical Center Geriatrics Research, Baltimore, Maryland, USA, Johns Hopkins University, Baltimore, Maryland, USA and University Hospital of Zurich, Zurich, Switzerland show that Bilateral arm training with rhythmic auditory cueing( BATRAC) is not superior to dose–matched therapeutic exercises (DMTE). However both rehabilitation programs durably improve motor function for individuals with chronic upper–extremity hemiparesis and with varied deficit severity.
The HandTutor system encourages upper extremity active exercise practice and has been proven effective in the treatment of chronic upper–extremity hemiparesis patients.

Pediatric Therapists Report Sensory Issues Commonly Mistaken for ADHD and treatment is the therapy and not medication

CHICAGO, Feb. 17, 2011 /PRNewswire/ -- A new survey from Pathways Awareness http://bit.ly/et8IgA of more than 500 pediatric occupational therapists, physical therapists and speech-language pathologists reports that more than two-thirds (68 percent) evaluated or treated children between 3 and 8 years old who had been previously misidentified with learning disabilities or behavioral issues. Of that two-thirds, an overwhelming majority (90 percent) reported they had seen children with deficits processing and integrating sensory information who had been misidentified as having Attention Deficit Disorder (ADD) or Attention-Deficit Hyperactivity Disorder (ADHD).
Members of the American Occupational Therapy Association (AOTA), the American Speech-Language-Hearing Association (ASHA), the Pediatric Section of the American Physical Therapy Association (APTA) and the Neuro-Developmental Treatment Association (NDTA) participated in the survey.
The HandTutor system is used by occupational therapists to treat development delay and the virtual functional tasks work on the childrens' motor sensory and cognitive movement impairments.

Movement facilitation following incomplete spinal cord injury

In the February edition of the Journal Neurorehabilitation and Neural Repair http://bit.ly/eFxELQ Dr. Popovic and his group from the Toronto Rehabilitation Institute report that functional electrical stimulation (FES) therapy on a group of subacute incomplete tetraplegia patients worked better than conventional occupational therapy alone to increase patients’ ability to pick up and hold objects.
Based on their findings, the study’s authors recommend that stimulation therapy should be part of the therapeutic process for people with incomplete spinal cord injuries whose hand function is impaired.
Numerous neurological and orthopedic disease or injuries such as a stroke damage significantly the patient movement ability. The major movement drawbacks that lead to loss of movement ability are the difficulty to produce initial movement and disturbance of tactile sensation in the affected area of the body. Popular therapeutic tools such as Neuromuscular Electrical Stimulation (NMES), Electromyography (EMG) and Transcutaneous Electrical Nerve Stimulation (TENS) are well known and proven approaches to facilitate movement in the physical rehabilitation field. Once movement has been facilitated the physical and occupational therapist has to work on improving the patients active movement ability by means of intensive active exercise practice. The HandTutor, ArmTutor and LegTutor systems allow the therapist to customize the task practice to the patients movement ability. At the same time quantitative assessment and objective follow up provided by the HandTutor system ensure better functional movement ability outcome.

Interprofessional community-based stroke rehabilitation superior to usual care in acute stroke

In the February edition of The Canadian Journal of Neurological Sciences http://bit.ly/hPd1fE Dr. Markle-Reid and her team from Master University, Hamilton, Ontario, Canada compared an interprofessional stroke rehabilitation approach to usual care in 82 acute post 18 months community-based stroke rehabilitation patients. The primary outcome was change in health-related quality of life and functioning. The group found that stroke survivors in the intervention group showed clinically important improvements in physical and social functioning scores. Although there was a higher total per-person costs of use of health services in the intervention group compared to usual home care the difference was not statistically significant. The Canadian group concluded that a specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care.
The HandTutor and ArmTutor for upper extremity arm and hand rehabilitation and the LegTutor and 3DTutor systems for hip and knee lower extremity rehabilitation incorporate the concept of virtual functional tasks which are used to motivate the patient to do intensive active exercise practice are used by the patient in clinic and at home with home care patients being supported by tele-rehabilitation.

Restoring near-natural arm, hand and finger function to patients suffering from spinal cord injury, stroke or amputation

On Feb. 8, The Food & Drug Administration unveiled a new, fast-track protocol for breakthrough medical technologies this week, saying its new "Innovation Pathway" aims to speed high-tech devices to market.

Projects tapped for the innovation program would have to be "truly pioneering" and capable of "revolutionizing patient care or healthcare delivery" to be eligible. Those tapped would receive roadmap and timeline from the Center for Devices & Radiological Health (CDRH) for the development, testing and review of the device. An FDA "case manager" would be assigned to each project, to help identify and address "important scientific issues" early on.

The HandTutor system measures isolated and coordinated finger and wrist movement. The dedicated rehabilitation software allows for movement guidance to show the patient how to move their hand or prosthetic and augmented feedback to show that the prosthetic is moving. A combination of guidance and visual augmented feedback allows for learning motor movement.

Youngsters with ADHD exhibited more than twice the amount of unintentional extra or "overflow" hand movements

In joint research published in the February edition of Neurology http://bit.ly/dXtqvp Dr. Donald Gilbert, director of the TMS Library at Cincinnati Children's Hospital Medical Center and colleagues from Kennedy Krieger Institute in Baltimore showed that youngsters with ADHD exhibited more than twice the amount of unintentional extra or "overflow" hand movements ADHD affects about 8 percent of American children, ADHD is a developmental disorder characterized by inattentiveness, impulsiveness and/or hyperactivity. According to recent studies, two-thirds of those with ADHD also struggle with other mental health and developmental conditions such as anxiety and learning disabilities and delay in motor skill development
The HandTutor system can help to improve children's eye hand co-ordination and treat children with fine motor skill problems and improve grip strength and improve functional performance of handwriting and cutting etc. The HandTutor provides active exercises through rehabilitation games that can train and improve the specific deficit in the ability of the child to use the appropriate grip strength thumb and index finger) to hold the pencil or pen. Fine motor training intended to improve this disability needs to work on exercises that teach the child how to balance the strength in the index finger and thumb flexor (closing) and extensor (opening) muscles.

The language system of the brain is functionally interwoven with perceptual and motor systems.

In the February edition of Nature Reviews Neurology http://bit.ly/iglaQ5 Dr Berthier Professor of Neurology and Director, Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Spain and Dr. Pulvermüller Programme Leader, Cognitive Neuroscience of Language, Medical Research Council Cognition and Brain Sciences Unit; Fellow, Wolfson College, Cambridge University, Cambridge, United Kingdom discuss neuroscience insights and therapy to improve neurorehabilitation of poststroke Aphasia.
They state that the treatment of aphasias—acquired language disorders—caused by stroke and other neurological conditions has benefitted from insights from neuroscience and neuropsychology. Massed practice and exploitation of residual neurological capacities can aid neurorehabilitation of patients with poststroke aphasia, and progress in basic neuroscience research indicates that the language system of the human brain is functionally interwoven with perceptual and motor systems. Intensive speech and language therapies, including constraint-induced aphasia therapy, that activate both the linguistic and concordant motor circuits utilize the knowledge gained from these advances in neuroscience research and can lead to surprisingly rapid improvements in language performance, even in patients with chronic aphasia.
The HandTutor, ArmTutor and LegTutor systems provide motivation to the patient to do repetitive virtual functional task practice or massed active exercise practice which is proven to improve sensory, motor and cognitive movement ability and aid in the function of active daily living tasks which increases patient independence post stroke.

The HandTutor, ArmTutor and LegTutor systems used effetively for movement dysfunction due to pain

In the February edition the Journal of Electromyography and Kinesiology http://bit.ly/hi7nG3 Dr. Hodges from the University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane Australia discusses pain and motor control. He notes movement is changed in pain with the patient exhibiting functional motor adaptation to pain activity with a modification in the mechanical muscoskeletal behaviour and movement pattern. This adaptation is undertaken to “protect” the tissues from further pain or injury. This protection from pain is of short-term benefit, but has potential long-term consequences due to factors such as increased load, decreased movement, and decreased variability in movement. The objective is therefore to break the cycle of pain leading to decreased active exercise leading to decreased mobility leading to functional disability. The HandTutor, ArmTutor and LegTutor systems provide motivation to the patient to do repetitive virtual functional task practice and has been used effectively with CRPS patients. The improved functional movement outcome may be due to the fact that the augmented feedback from the virtual functional tasks provides motivation to the patient to exercise and draws their attention and concentrate away from the pain this then improves the patients joint and limb mobility.

Home Care stroke patients achieve similar outcome walking results to in clinic patients

National Institutes of Health steering committee shows that stroke patients who had a home physical therapy exercise program improved just as well as those who did the locomotor training.
Results from the LEAPS Locomotor Experience Applied Post Stroke Trial presented were presented by Dr. Bruce Dobkin at the American Stroke Association's International Stroke Conference 2011 in Los Angeles. The study funded primarily by the NIH's National Institute of Neurological Disorders and Stroke, with additional support from the National Center for Medical Rehabilitation showed that at an home walking exercise program achieved similar gains to a body-weight supported treadmill program.
The body-weight supported treadmill training and home based walking practice was started at two different stages, either two months after stroke or six months after stroke with the early intervention group achieving better functional gains. Outcome measures used included speed and distance of the patients walking, their physical mobility, motor recovery and social participation and improvement in quality of life. It was further concluded that the at home exercise program supported by a physical therapist required less expensive equipment, less training for the therapists and fewer clinical staff members.
"We were pleased to see that stroke patients who had a home physical therapy exercise program improved just as well as those who did the locomotor training,'' said LEAPS principal investigator Pamela W. Duncan, a professor at Duke University School of Medicine and a former student of Dobkin's. "The home physical therapy program is more convenient and pragmatic. Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life."
The LegTutor and 3DTutor systems incorporate the concept of virtual functional tasks which are used to motivate the patient to do intensive active exercise practice. The LegTutor can be used by patients who can not support their body weight as well as by patients doing closed chain standing exercises. The LegTutor and 3DTutor provide both feedback on the patient’s movement ability and instructions on how to move the joint in association with another joint thus allowing for exercise training without the patient adopting compensatory movement patterns. This allows the patient to practice isolated and combined movements of the hip and knee and ankle when they exercise with the LegTutor and 3DTTutor. The system can be used by the patient in clinic and at home with home care patients being supported by tele-rehabilitation.

Neural Interfaces for Control of Upper Limb Prostheses: The State of the Art and Future Possibilities

In the February Physical Medicine and Rehabilitation PM&R http://bit.ly/fRWtH9 Dr. Schultz and Kuiken from the Neural Engineering Center for Artificial Limbs, Rehabilitation Institute of Chicago; and Department of PM&R, Northwestern University Feinberg School of Medicine, Chicago USA discuss current treatment of upper limb amputation that restores some degree of functional ability. They state that although acceptance rates can be high when patients are highly motivated and receive proper training and care, current prostheses often fail to meet the daily needs of amputees and frequently are abandoned. Recent advancements in science and technology have led to promising methods of accessing neural information for communication or control. Researchers have explored invasive and noninvasive methods of connecting with muscles, nerves, or the brain to provide increased functionality for patients experiencing disease or injury, including amputation. These techniques offer hope of more natural and intuitive prosthesis control, and therefore increased quality of life for amputees.
The combination of real time movement guidance and visual augmented feedback given during and after completion of the virtual functional exercise task allows patients to learn how to move their hands. In this way, the HandTutor system will allow patient’s with prosthetic hands to learn how to do isolated and coordinated finger movements. The HandTutor system is being used to improve hand movement dysfunction in patients post stroke, spinal cord injury and cerebral palsy as well as other neurological and orthopedic arm injury and disease.

FDA's "Innovation Pathway". How the HandTutor system can teach patients to use a bionic hand

The Food & Drug Administration FDA launches Medical Device "Innovation Pathway". This initiative aims to speed the introduction of breakthrough medical devices. The first project is the brain-controlled, upper-extremity prosthetic. This project follows on from the DARPA-funded prosthetic bionic arm and hand project. The initiative aims to speed the introduction of a military project to create a prosthetic arm http://bit.ly/gv2bmp.
The HandTutor system measures isolated and coordinated finger and wrist movement. The dedicated rehabilitation software allows for movement guidance to show the patient how to move their hand or prosthetic and augmented feedback to show that the prosthetic is moving. A combination of guidance and visual augmented feedback allows for learning motor movement.

Reducing spasticity during intensive exercise practice and functional improvement in Cerebral palsy patients

In the February edition of Developmental Medicine & Child Neurology http://bit.ly/fFQuGZ Dr. Ryll from Department of Epidemiology, Maastricht University report on the effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: His team reviewed randomized controlled trials assessing functional outcomes on walking of children with CP following botulinum toxin injection. The team conclude that the use of BoNT-A with usual care or physiotherapy seems to improve walking of children with CP.

The HandTutor, ArmTutor are upper extremity arm, hand - finger/s wrist and lower extremity rehabilitation systems that encourage active exercise practice by motivating the patient to perform virtual functional exercise tasks. The virtual functional tasks work on interjoint coordination as well as other movement parameters including range of motion, speed and strength of movement. When combined with task practice the HandTutor and ArmTutor for upper extremity fine motor skill neuro rehabilitation and the LegTutor for lower extremity rehabilitation have been proven to improve functional movement performance in CP patients.

Long-term follow-up of botulinum toxin therapy for focal hand dystonia: Outcome at 10 years or more

In the February edition of Movement disorders http://bit.ly/dFTO4n Dr. Codrin Lungu and his team from Beth Israel Deaconess Medical Center Boston USA report on a retrospective study to assess the efficacy and safety of botulinum neurotoxin (BoNT) treatment for Focal hand dystonia (FHD). The group show that BoNT therapy for FHD remains safe and effective after more than a decade of treatment even though the dose of botulinum toxin needed to be increased.
An experienced occupational and physical therapist can reduce spasticity during patient treatments. When the patient has reduced tone they need to improve their level of sensory motor movement ability through intensive isolated and coordinated task practice. When the tone returns post treatment session the patient can continue doing functional tasks and maintain the improved movement ability. The HandTutor, ArmTutor and LegTutor systems allow the patient to do intensive active exercise practice during treatment sessions and have been shown to sustain patient functional improvement post intervention.

Effects of Exercise on Quality of Life in Stroke Survivors (HRQoL)

In the February edition of stroke http://bit.ly/i3MCI2 Dr. Ming-De Chen of Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago USA detail clinical trials that support the use of exercise to improve health related quality of life in stroke survivors. They conclude that the challenge for researchers is identifying effective strategies for sustaining these effects post intervention.
The HandTutor, ArmTutor and LegTutor are upper arm, hand - finger/s wrist and lower extremity rehabilitation systems indicated for patients in rehabilitation centers, private clinics and the home care environment. The home care patient can benefit from tele-rehabilitation. The HandTutor and other Tutor systems use dedicated rehabilitation software that employs motivating games that can be customized to the stage of rehabilitation and the patient’s movement dysfunction. The virtual functional tasks employed ensure that the patient undertakes intensive repetitive active exercise practice with the games being motivating and well tolerated. The HandTutor, ArmTutor and LegTutor systems have been shown to sustain patient functional improvement post intervention.

Isolated, combined and co-ordinated exercise practice improves functional movement ability in spinal cord injury patients

In the February edition of the Journal of Neuro Engineering and Rehabilitation 2011 http://bit.ly/ggKWEw Dr. Angel Gil-Agudo and his group from the Department of Physical Medicine and Rehabilitation, National Hospital for Spinal Cord Injury Toledo Spain report on Gait kinematic analysis in patients with a mild form of central cord syndrome
Central cord syndrome (CCS) is considered the most common incomplete spinal cord injury (SCI). CCS accounts for approximately 9% of traumatic SCIs. It is characterized by disproportionately greater motor impairment in upper compared to lower extremities.
The gait characteristics of subjects with CCS compared with healthy subjects. The gait pattern of CCS patients showed a decrease of knee and ankle sagittal ROM during level walking and an increase in hip abduction to increase base of support.
The HandTutor, ArmTutor and LegTutor systems incorporate the concept of virtual functional tasks. These tasks allow the patient to be given intensive active exercise practice and targeted movement feedback on the position of one, two or more joints. The HandTutor, LegTutor and 3DT Tutor provide both feedback on the patients movement ability and instructions on how to move the joint in association with another joint. This allows the patient to practice isolated and combined movements of the hip and knee and ankle when they work with the LegTutor and 3DTTutor. When the patient works with the HandTutor and ArmTutor system they practice isolated and combined movements of the shoulder, elbow, wrist and fingers. This allows the patient to do intensive task practice that will teach them how to do coordinated movements of two or more joints. Motor learning that teaches the patient how to move more than two joints in a coordinated pattern will improve functional movement ability and the performance of the everyday tasks e.g. walking and reaching.

Evidence for brain recovery following intensive exercise practice

In the January edition of Advances in Brain Recovery and Rehabilitation http://bit.ly/f6wALm Dr. Zorowitz from Department of Physical Medicine and Rehabilitation The Johns Hopkins University School of Medicine, and the Department of Physical Medicine and Rehabilitation, Johns Hopkins USA and Dr. Brainin from Danube University and Danube Clinic, Department Chairman and Director, Department of Neurology Krems Austria discuss discoveries in the past year that have impacted the understanding of brain recovery. The review reports various approaches to neurorehabilitation, and associated evidence that supports post stroke following rehabilitation.
The HandTutor and ArmTutor system is used in both rehab clinic and home care. Evidence shows that intensive active exercise in both acute and chronic stroke patients will improve functional movement ability and quality of life.

Review of the randomized clinical stroke rehabilitation trials in 2009

In the February 2011 edition of Med Sci Monit http://bit.ly/dSnr1h , Dr. Rabadi and his team from Department of Neurology, Veterans Affairs Medical Center, Oklahoma University, Oklahoma City, U.S.A.
present a review of the randomized clinical stroke rehabilitation trials in 2009.
The review details evidence on interventions for motor recovery after stroke that showed improvements in recovery of arm function. These interventions included high-intensity physiotherapy and repetitive task training. Techniques reviewed include constraint-induced movement therapy, electromyographic biofeedback, mental practice with motor imagery, robotics and biofeedback. Exercise programs for community dwelling stroke patient helped maintain and improve the patient’s functional ability and HRQOL.
The HandTutor and ArmTutor system is used in rehabilitation clinic, private OT/ PT and home care settings with proven efficacy for both acute and chronic upper extremity stroke rehabilitation.

The HandTutor system is effective in patients with significant spasticity and or tone

It is possible for an experienced occupational and physical therapist to reduce spasticity for short term during therapy. During the treatment the therapists encourage the patient to do intensive exercise practice. The practice is a combination of task orientated training or task specific training and virtual functional training concentrating on movement impairments (impairment oriented training) e.g. coordination provided by the HandTutor system. This intensive practice will improve the patient’s sensory motor and cognitive movement ability. Thus the aim of the treatment is to allow the patient to have the continued ability to do functional tasks when spasticity returns following treatment. However with high Ashworth score it is not possible to do task specific training. Therefore the HandTutor system allows the patient the possibility to begin to do active exercise training even when they have very limited movement ability. In cases when the patient does not have the ability to open or close his fingers then the therapist can open the patients hand when they feel the patient working with them and not against them.

What are Comprehensive Stroke Centers

January 21, 2011 — The American Heart Association and the American Stroke Association (AHA/ASA) have developed a series of 26 standardized metrics for use by comprehensive stroke centers (CSCs) across the United States to measure and monitor quality of care.

The proposed metrics, and the research backing them, were published online January 13 and will appear in the March issue of Stroke: Journal of the American Heart Association http://bit.ly/haMUSn

Comprehensive stroke centers (CSCs) represent a more intensive level of stroke care than what is available at primary stroke centers (PSCs).
"This is going a step further," said the chair of the paper's writing group, Dana Leifer, MD, associate professor of neurology at Weill Cornell Medical College, New York City. "This is designating certain hospitals with more specialized and advanced methods for treating stroke patients, so patients with more complications or more complicated stroke."

Designating and Certifying Hospitals

Establishing the new metrics is part of an effort to create mechanisms for designating and certifying hospitals in the field of stroke care.

"It's similar to the idea that there are different levels of trauma centers," said Dr. Leifer. "What we are doing in this paper is essentially proposing a standardized set of metrics and other data that CSCs should collect so that the care they provide can be assessed."

In 2005, the Brain Attack Coalition, a joint effort of the AHA and ASA, proposed an infrastructure of personnel, equipment, and protocols for CSCs and called for quality improvement mechanisms and registries to record how patients should be treated. The new recommendations, developed after an extensive review of the literature, are based on experience with previous quality improvement initiatives, such as the Get With The Guidelines (GWTG) program.

Ralph Sacco, MD, president of the AHA and chief of neurology at the University of Miami's Miller School of Medicine and Jackson Memorial Hospital in Florida, said the new recommendations can help provide the basis to monitor and track performance.


Optimal rehabilitation outcome requires customization of intensive repetitive exercises, qualitative assessment and reporting the HandTutor, ArmTutor and LegTutor provide an augmented guidance and feedback exercise program to encourage exercise practice and reduce the dependence on compensatory movement patterns.

Effects of passive-active movement training on upper limb motor function and cortical activation in chronic patients with stroke:

From the archives of J Rehabil Med. 2004 http://bit.ly/gSMcId Dr. Lindberg and his team from Department of Neuroscience, Rehabilitation Medicine, Uppsala University Hospital, Sweden show that chronic patients with stroke with paresis of the upper limb who complete 4 weeks of daily functional exercises improve hand motor function and ability. This was accompanied by changes in cortical activation shown by functional magnetic resonance imaging which suggest reorganization of areas related to movements of the paretic limb.

The HandTutor and ArmTutor system allow for customization of virtual functional tasks. The virtual functional tasks provide the patient with visual guidance on how to complete the task and feedback on their success in completing the task. Guidance and feedback allow for better motor learning and optimization of functional performance outcome.