Rehabilitation using the HandTutor, ArmTutor and 3DTutor prevents compensatory trunk torsion during reaching functional tasks

In the March edition of Brain Research http://bit.ly/eMERcK Dr Johanna V.G. Robertsonlow and Agnès Roby-Bramia from Laboratoire de Neurophysique et Physiologie, Université Paris Descartes, CNRSParis, France and the Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches studied trunk torsion degrees of freedom during reaching movements in healthy subjects and hemiparetic patients. The 3D trunk motion participates in reaching within arm's length in healthy subjects however trunk flexion is increased in stroke patients during reaching movements and the additional degrees of trunk torsion freedom participates in the compensatory strategy in hemiparetic patients.
Rehabilitation using the HandTutor and ArmTutor system incorporates the 3DTutor. Secondary feedback from the 3DTutor is displayed during active reaching movements of the arm. In this way the patient is given augmented feedback on the position and movement of their trunk during the function and is given real time movement guidance on how to reposition the trunk during the functional movement and avoid learning a compensatory movement pattern.

HandTutor system answers the 2009 American Heart Association (AHA) Policy Statement on stroke systems of care

In 2009 the American Heart Association issued a AHA Policy Statement that appears in Stroke magazine http://stroke.ahajournals.org/cgi/content/full/40/7/2635 discussing recommendations for the implementation of telemedicine within stroke systems of care. In regards to sub acute stroke treatment, the report states that many small hospitals do not have specialists with training and expertise to treat patients in medical sub specialties, including physical, occupational and speech therapy, and rehabilitation medicine.
Stroke rehabilitation involves coordinated interventions from a multidisciplinary team in order to achieve the best potential functional outcome. and should be provided by an appropriately trained and staffed that follows established practice guidelines. Impaired recovery outcomes has been noted in patients with geographically and or financially limited access to appropriate rehabilitation services. The report concludes that telemedicine for rehabilitation (telerehabilitation) may be a practical and valuable approach to delivering post stroke care when limited resources, manpower shortages, long distances, or limited patient mobility prevent or limit access to indicated rehabilitation therapies.
In a recent statement by Steven L. Wolf, PhD, professor of rehabilitation medicine at Emory University School of Medicine millions of Americans face challenges in accessing health care, with rural residents experiencing more limitations of activity caused by chronic conditions such as stroke than urban residents. Additionally, insurance carriers often do not cover lengthy rehabilitation programs for stroke survivors, causing many patients to lose the proven benefits of aggressive therapy following a stroke.
Prof Wolf also states that “A tremendous amount of research has led to advances in stroke therapy through the identification of the importance of task practice and intensity of therapy. However, we know that many patients, in particular those living in rural and under served areas, do not receive quality post-stroke rehabilitation.

The EU policy states all European stroke patients should have access to a continuum of care, including organized acute stroke units, appropriate rehabilitation, and secondary prevention measures and the 2006 World Health Organization Helsingborg Declaration on European Stroke Strategies declared that tele-rehabilitation is a vital element to achieving this goal.
The HandTutor system is being used for stroke and other brain and spinal cord injury, cerebral palsy, brachial plexus injury patients, with the patient undergoing intensive exercise practice at home with tele-monitoring from a remote location ensuring patient compliance and maximum motivation.

Community-based upper-extremity rehabilitation improves motor function and performance of functional activities in chronic stroke

In the Arch Physical Medical Rehabilitation http://1.usa.gov/hAQpOz Dr. Pang and his colleagues from School of Rehabilitation Sciences, University of British Columbia, Rehabilitation Research Laboratory, GF Strong Centre, Vancouver, BC, Canada assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke. The patients underwent an exercise program designed to improve upper-extremity function (1h/session, 3 sessions/wk for 19wk). The group found that community-based exercise program can improve upper-extremity function in persons with chronic stroke.
The HandTutor and ArmTutor system is proven to improve upper extremity function in pateints with arm movement dysfunction in both rehabiliation clinic and the home.

HandTutor and ArmTutor systems used to give customized and motivating intensive exercise practice

In the March edition of Clinical Rehabilitation http://bit.ly/hC2IvQ, Dr. Stephen Page and his group from the Departments of Rehabilitation Sciences, Physical Medicine and Rehabilitation, University of Cincinnati Academic Medical Center, Cincinnati, OH, USA compare longer versus shorter mental practice sessions for affected upper extremity movement after stroke. The group found that regardless of dosing condition, subjects administered mental practice exhibited markedly larger score changes on both the FM and ARAT than subjects not receiving mental practice.
Mental practice can be used in Arm and HandTutor system treatments as the dedicated rehabilitation devices allow the therapists to tailor and customize the patients exercise to their movement ability. This keeps the patient motivated to continue intensive exercise practice.

Effective rehabilitation of older people in a district rehabilitation centre

In the March edition of Journal of Rehabilitation Medicine http://bit.ly/gdpzXF Dr. Inger Johansen and her group from Department of General Practice/General Practice Research Unit University of Oslo, Oslo, Norway assess the outcome of rehabilitation of older patients in a district rehabilitation centre following referral from district hospital, nursing homes or their own homes following stroke, arthrosis, hip fracture and other neurological and orthopedic injuries and chronic diseases. The group found that significant and persisting improvements in activities of daily living were achieved by rehabilitation of older patients with stroke, arthrosis, hip fracture and other chronic diseases in a district inpatient rehabilitation centre with co-ordinated and multi-disciplinary rehabilitation.
The HandTutor and ArmTutor are used in clinic, nursing home and home care to give patients upper extremity arm and hand intensive active exercise rehabilitation and the LegTutor and 3DTTutor allow physical therapists to customize lower extremity rehabilitation exercises that motivate the pateints to achieve optimum rehabilitation outcome.

Virtual functional tasks train sensory, cognitve and movement impairments

In the March edition of Clinical Rehabilitation http://bit.ly/hrDpIi , Dr. Makoto Hiyamizu and her group from Department of Physical Therapy, Faculty of Health Science, Kio University, Nara, Japan look at the effects of dual task balance training on dual task performance ability in elderly people. The group found that dual task balance training in elderly people improves their dual task performance during standing postural control.
The LegTutor and 3DTTutor allow the therapist to train sensory, cognitive and movement impairments and to motivate patients with challenging tasks that enable them to do intensive active exercise practice.

Inpatient and Postdischarge Rehabilitation Services Provided in the First Year After Spinal Cord Injury: Findings From the SCIRehab Study

In the March edition of the Archives of Physical Medicine and Rehabilitation Dr. Whiteneck and his group from Craig Hospital Engelwood NJ look at the break down in rehabilaition treatments given before and after hospital discharge for Spinal Cord Injury patient. The group found that of the total hours spent on these rehabilitation interventions during the first year after injury, 44% occurred after discharge from inpatient rehabilitation. Participants received 56% of their PT hours after discharge and 52% of their OT hours.
The HandTutor, ArmTutor and LegTutor system is being used by OT's and PT's with SCI patietns both in acute, sub acute, outpatient and home care environments.

In the March edition of Clinical Rehabilitation http://bit.ly/ei1jp2 Dr Nuria Sa´nchez Labraca and her team from the Department of Nursing and Physical Therapy, University of, Almeria (UAL), Spain and the Department of Physical Therapy, University of Granada (UGR), Spain investigated the benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty. The study found that the initiation of rehabilitation within 24 hours of total knee arthroplasty reduced the hospital stay and the number of sessions required for patients to achieve autonomy
The earlier onset of treatment also reduced pain and improved the range of motion and muscle strength.
The LegTutor system is used to encourage and motivate the patient to do intensive exercise practice. The virtual functional tasks can be used in both open and closed kinetic chain exercises. This allows practice of exercises that work on range of motion, strength and motor control.

Use it or lose it: The HandTutor system enncourages intensive massed exercise practice to regain lost movement ability following stroke

In the past Stroke patients who couldn't use an injured arm or hand were taught to dress and bathe with their good arm. This means the patient was taught a compensatory strategy to achieve the active daily living (ADL) function. This was because until recently scientists thought that when a region of the brain was damaged, its function was lost forever.

However, sophisticated imaging tests of the brain e.g. fMRI have revealed that the brain amazingly can reorganize itself after injury so that when nerve cells die, their functions are taken over by other areas of the brain. This concept is known as neuroplasticity. The concept of neuroplasticity has changed stroke rehabilitation therapy considerably.

"Now we know that if you want to get motor recovery on the affected side, you have to use the affected side—repetitively and intensively," says Richard Zorowitz, M.D., chief of physical medicine and rehabilitation at the Johns Hopkins Bayview Medical Center in Baltimore, Md. "That stimulates the brain to make those new connections."

Neuroplasticity is the principle behind the HandTutor, ArmTutor and LegTutor systems that provide motivating and customized virtual task exercise therapy that allow the patients regardless of their movement ability to do intensive and massed exercise practice.

Neurotransmitter could improve post-stroke rehabilitation

Neurotransmitter could improve post-stroke rehabilitation

March 10, 2011
Christian Grefkes from the Max Planck Institute for Neurological Research in cooperation with scientists from the Institute of Neurosciences and Medicine of the Forschungszentrum Jülich and the Department of Neurology of the University Hospital of Cologne looked at eleven stroke patients (between 42 and 74 years old) with fine motor deficits. The group carried out a range of motor tasks which involved the determination of maximum grip power and finger-tapping frequency and the execution of pointing movements. The group showed that by reducing the rate of uptake of noradrenaline which in effect prolongs the efficiency of noradrenaline improves motor skills in stroke patient.

Intensive active exercise practice provided by the HandTutor, ArmTutor and LegTutor system has proven effective in improving functional movement ability in post stroke patients.

Using the HandTutor system improves DCD

In the March edition of Res Dev Disabil http://1.usa.gov/eqLKpL Dr. Nakai and his group from Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Japan investigated the relationship between coordination, fine motor movement and attention-deficit hyperactivity disorder (ADHD) tendencies or intelligence. The group used a Japanese version of the Developmental Coordination Disorder (DCD) Questionnaire as a screening tool for clumsiness. The group found that DCD, ADHD and children's grades are linked with academic performance improving in line with improvement in fine motor movement ability.
DCD interferes with academic performance and participation in physical activities and psychosocial functions, such as self-esteem, cognition, or emotion, from childhood through adolescence to adulthood. DCD is a common pediatric condition and its prevalence is estimated to be 6% worldwide.
The HandTutor system has been shown to improve fine motor movement ability in patients with DCD.

HandTutor, ArmTutor and LegTutor system provide objective evaluation and follow up

Objective evaluation and follow up combined with customized exercise practice are the fundamentals in physical and occupation therapy treatment of neurological and orthopedic injury and disease and will ensure optimal functional improvement and improve the patients quality of life. Functional assessment including the WOLF MOTOR FUNCTION TEST (WMFT) quantify upper extremity motor ability through timed and functional task assessments however, you will see from this demonstration and scoring protocol that the assessment has a large subjective element http://bit.ly/g3UPrE

In the March issue of Topics in Stroke Rehabilitation http://bit.ly/h03MW7 Dr. Gregory and his team from Department of Physical Medicine and Rehabilitation and the Department of Neurology, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina USA compare patient preferences for Stroke Rehabilitation. The group conclude that patients prefer the initial rehabilitation therapy setting to be at home. Providers should inquire about patient preference and provide information about treatment options to help inform decision making.
The group also state that early aggressive rehabilitation therapies maximize functional recovery.
The HandTutor, ArmTutor and LegTutor systems provide the patient with user friendly upper and lower extremity dedicated rehabilitation devices that allow for intensive exercise practice and maximize functional recovery both in acute, sub acute, outpatient and home care settings.

HandTutor, ArmTutor, LegTutor, plasticity and functional outcome measures

In the March edition of Neurorehabil Neural Repair Dr. Butler and his team from Department of Rehabilitation Medicine, Emory University School of Medicine and Atlanta Veterans Administration Medical Center, Atlanta, GA, USA show a correlation between clinical outcome measures, such as the Wolf Motor Function Test (WMFT) and the upper limb portion of the Fugl-Meyer (FM) motor assessment, and neuroimaging techniques, such as diffusion tensor imaging (DTI) and blood oxygenation level–dependent (BOLD) functional magnetic resonance imaging (fMRI).
Treatment using virtual functional tasks provided by the HandTutor, ArmTutor, LegTutor system have been proven to improve the patients functional ability in neurological and orthopedic injuries and disease.

HandTutor, ArmTutor and LegTutor provide evidence based stroke functional rehabilitation

In the March edition of the BMJ http://bit.ly/fVDXca Dr. Bhalla consultant stroke physician from and her group from Kings College London compare the provision of acute care in South London from 1995-2007. The group found that the likelihood of those with a functional deficit receiving rehabilitation increased significantly over time with patients aged 75 or more being more likely to receive occupational therapy or physiotherapy. however the group found that implementation of evidence based care was not optimal.
The HandTutor, ArmTutor, LegTutor allows physios and occupational therapists to provide evidence based active exercise rehabilitation task training.

Tele-rehabilitation for chronic pain patients

In the March edition of Health Expectations http://bit.ly/fM1ZKW Dr. Cranen from University of Twente in the Netherlands investigated chronic pain patients’ perceptions of home telerehabilitation services. The group found that the effect of telerehabilitation on healthcare strongly depends on patients’ willingness to use.
The HandTutor system has been used successfully to treat patients with hand movement dysfunction caused by chronic pain including Complex regional pain syndrome CRPS. The HandTutor system should be introduced into the treatment schedule as early as possible so as to prevent disuse leading to contractiures and a loss in active movement ability. The virtual functional tasks motivate the patient to continue movement practice.

Preventing contractures at the wrist after stroke improves functional recovery of the upper limb

In the March edition of Clinical Rehabilitation http://bit.ly/eE2Wtj Dr. Malhotra and her team from School of Health and Rehabilitation, Keele University, UK and Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital, USA investigate the time course of development of spasticity and contractures at the wrist after stroke and explore the association with upper limb functional recovery. The group found that participants who recovered arm function showed signs of spasticity at all assessment points but did not develop contractures. Contractures were more likely to develop in patients who did not recover arm function.
The HandTutor and ArmTutor system encourages active exercise practice with the patietn being motivated early after stroke to stretch actively elbow, wrist and fingures which helps to prevent the onset of contractures.

Home based computer-assisted upper limb exercise for young children with cerebral palsy

In the March edition of Journal of Rehabilitation Medicine http://bit.ly/fBCSi6 Dr. Weightman and his colleagues form the Academic Unit of Rehabilitation Medicine, University of leeds reported improvements in self-reported function and quality of arm movements observed following the use of a home based arm rehabiliaiton system. The system was used to augment home-based arm exercise in an engaging way for children with cerebral palsy.

The HandTutor and ArmTutor systems is used to give tele-rehabilitation worl wide to children with arm and hand movement impairments and to supplement tradition occupational and physical therapy.

Association of arm motor impairment on arm use and functional ability and quality of life post stroke

In the March edition of Journal of Rehabilitation Medicine http://bit.ly/hczDty Dr. Gyrd Thrane and his team from the Department of Physical rehabilitation University of Tromsø, Norway assess the effect of arm motor impairment on actual arm use, measured by an accelerometer, in the early post-stroke period. The group found that Fugl-Meyer Motor Assessment (FMA) score was associated with Arm movement ratio (AMR) score, the ratio of arm use duration between the more and less affected arm.
The HandTutor and ArmTutor system encourages the patient to actively exercise their impaired hand and arm in order to train arm and hand movement impairments and increase arm and hand movement ability and functional outcome.