The LegTutor system is used to customize isolated and coordinated knee and hip exercises and is used to improve patient functional walking ability

In the April edition of Physical Medicine and Rehabilitation http://bit.ly/iJ4Fzr, Dr Watt and his team from Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA discuss Effect of a Supervised Hip Flexor Stretching Program on Gait in Elderly Individuals.
The group looked at eighty-two healthy elderly individuals, with 39 subjects in the control group and 43 subjects in the treatment group. The treatment group completed a 10-week, twice-daily hip flexor stretching program, which was supervised twice weekly by a rehabilitation clinician. The 10-week supervised hip flexor stretching program was effective in increasing stride length and peak hip extension during walking in elderly adults who had limited preintervention hip extension during walking. These results support the use of a simple stretching program for elderly individuals in counteracting age-related decline in gait function.
The LegTutor system is used to customize isolated and coordinated knee and hip exercises and is used to improve patient functional walking ability.

The HandTutor system is being used to treat MS patients and the virtual task practice trains motor, sensory and cognitive movement impairments.

In the April edition of the J Int Neuropsychol Soc http://1.usa.gov/j8GFjG Dr. Benedict and his team from Buffalo School of Medicine, Department of Neurology, and the Jacobs Neurological Institute, Buffalo, New York found that processing speed and executive function tests were significant predictors of lower and upper motor function in both healthy and Multiple Sclerosis (MS) patients. The cognitive tests predicted variability in motor function after controlling for disease duration and physical disability which has implications for risk assessment and treatment of mobility dysfunction in MS.

Exercising isolated and coordinated hand movment impairments using the HandTutor improves functional movement ability

In the April edition of Journal of NeuroEngineering and Rehabilitation http://bit.ly/iLXFlB Dr. Carpinella and her team from LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Milan, Italy compared spatial and temporal aspects of hand movement in 12 healthy volunteers and 14 hemiplegic stroke survivors.
The group found that in comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted.
The HandTutor system trains isolated and coordinated hand movement impairments in a motivating and challenging environment that promotes exercise practice in order to better achieve functional hand movement ability so that the patient can better perform everyday living tasks.

HandTutor improves fine motor co-ordination in children

Fine Motor Coordination

Fine motor coordination requires the use of the small muscles for finger dexterity to manipulate objects. Various functional and play activities will ensure the development of mature grasp patterns. Children with developmental delay have an impairment in the development of fine motor skills and will have difficulty picking up and manipulating small objects, button/zip clothes, color, build with Legos, dress doll babies and eat appropriately with fingers and utensils as well as difficulty in performing everyday daily tasks and activities.

Because fine motor coordination is developed through strengthening and using our hands, it is important to provide a variety of activities to develop well balanced muscles and coordination. In addition it is advisable to limit the use of hand held video games, watching TV, and computer activities.

Some ideas: Children need to dance, run and play outside, act out a story with dolls or action figures etc. Additionally, they need to color and draw . The below examples are fun ways to develop strength and coordination.

Strengthening:

* Dig in sand or dirt
* Play dough
* Stretch rubber bands around a cup or can
* Pop bubble wrap
* Squeeze a hole puncher
* Pick up cotton balls, small blocks, puzzle pieces with clips
* Squeeze clothes pins.
* Water play squirt toys, fill up and pour water out of various size bottles

Coordination

* Play with finger puppets
* Pick up objects with tweezers
* Puzzles
* String beads, noodles or cereal on pipe cleaners or string
* Play games such as memory, Hi HO Cherry Oh, Candy Land
* Wind up toys or spin tops
* Use tongs to stack block or pick up objects
* Flip coins over so all are “heads up” and place coins in a bank or container
* Find objects (buttons, shapes, letters) in a bowl of dry beans or rice
* While at restaurants keep busy by coloring, have small squeeze flashlight to shine on objects on the table, spinners or wind up toys.

he HandTutor system has been shown to improve fine motor movement ability in patients with DCD.

LegTutor and 3DTutor indicated for Active Movement Rehabilitation of Lower-Limb Impairments in Children With Cerebral Palsy

In the May edition of Neurorehabilitation and Neural Repair http://bit.ly/equBpT Dr. Yi-Ning Wu from Rehabilitation Institute of Chicago, Chicago, IL, USA and Dr. Miriam Hwang from Korea University College of Medicine, Seoul, Korea study Combined Passive Stretching and Active Movement Rehabilitation of Lower-Limb Impairments in Children With Cerebral Palsy using a portable robot. The group found that Passive stretching combined with engaging in active movement training was of benefit in this pilot study for children with CP. They demonstrated improvements in joint biomechanical properties, motor control performance, and functional capability in balance and mobility.
The LegTutor and 3DTutor trains isolated and combined hip, knee and ankle movement and focusses on leg motor control in order to improve functional walking outcome.

HandTutor and LegTutor system used in patietns with incomplete spinal cord injury

In the April edition of Neurorehabil Neural Repair http://bit.ly/ejZmRc Dr. Kelly Brunton and his team from the University of Alberta, Edmonton, AB, Canada research objective measures of functional walking in individuals with incomplete spinal cord injury. The group discuss The Spinal Cord Injury Functional Ambulation Profile (SCI-FAP) which was developed to address the need for a measure of functional walking in the spinal cord-injured population. The SCI-FAP involves the timed performance of seven common walking tasks, such as walking and negotiating obstacles, doors and stairs. The measure accounts for manual assistance and walking aids used. In this study the group show that the SCI-FAP has high inter-rater and test-retest reliability, as well as discriminative and convergent validity.
The LegTutpr and 3DTutor can be used to provide intensive lower extremity virtual functional exercise practice. The LegTutor uses a dedicated rehabilitation software that uses motivating games that can be customized to the stage of rehabilitation and the patients movement. The LegTutor encourages both open and closed kinetic loop active exercises.

The HandTutor system is being used effectively to mprove fine and gross motor performances of the upper limb in people with Parkinson disease.

In the May edition of American Journal of Physical Medicine & Rehabilitation http://bit.ly/hu8GqN Dr. Lee, Kyoung-Suk and is team from the Department of Physical Therapy, College of Health Science and Social Yonsei University Korea discuss the use of Modified Constraint-Induced Movement Therapy to improve Fine and Gross Motor Performance of the Upper Limb in Parkinson Disease.
The group concluded that Modified constraint-induced movement therapy improves fine and gross motor performances of the upper limb in people with Parkinson disease. Therefore, the therapy would be recommended as an effective treatment for them.

What is the difference between traditional therapeutic task practice used in constraint induced movement therapy and virtual functional task practice of the arm and hand with the HandTutor system?

Intensive and massed exercise practice has been proven to improve patient movement ability and the ability to do everyday living tasks. The HandTutor system employs virtual functional tasks. These are computer generated tasks or games that have been formulated to allow the therapist to customize which joint or combination of joint and which movement parameter will be exercised during the practice. In other words virtual functional tasks can be customized according to the patients movement ability. Therefore patients with very limited or no active movement ability can, through active assisted exercises, undertake intensive and massed movement practice. Similarly if the patient has better movement ability but still needs to work on pushing this ability to its limit the virtual tasks can be customized so that the patient needs to employ for example his maximum range of movement and or his maximum speed of opening of the fingers in order to succeed in the repetitive task. While the patient is performing the task they continue to receive instructions on how to do the task, how to correct compensatory movement patterns as well as feedback on their success in completing the task or adhering to the task requirements. This feedback is known as augmented motion feedback and teaches the patient how to move their arm and hands again.

The HandTutor system is being used effectively to mprove fine and gross motor performances of the upper limb in people with Parkinson disease.

HandTutor used with mental practice to improve hand movement ability

Mental practice or movement imagination is a training method where the patient imagines a movement without actually moving the limb that has movement dysfunction. Recently researchers have proposed the use of mental practice to facilitate motor recovery in stroke patients and other patients with motor disorders. Mental practice is the imagined rehearsal of a movement with the specific intent of improving that movement and it is suggested that during mental practice the motor control structures in the brain are activated in more or less the same way as during the actual performance of movements. This mechanism of improving limb movement has been reinforced by neuroimaging studies taken during motor imagery and show that the same brain areas are active as during actual movement. In addition, studies with healthy individuals have shown that motor imagery and actual action share some striking similarities. When someone is asked to perform a movement, for example, “walk along this line”, and to imagine the same movement, the time to complete the actual walking movement is similar to the time needed for completing the imagined walking movement.

HandTutor, ArmTutor system improves functional movement outcomes

In the April edition of The Journal of Bone and Joint Surgery (American) http://bit.ly/iiSMgj Dr. Smitherman and his group from Department of Orthopaedic Surgery, Greenville Hospital System University Medical Center, 701 Grove Road, USA investigated the functional outcomes, following single-event multilevel surgery of the upper extremity in children with hemiplegic cerebral palsy. The group found that children with hemiplegic cerebral palsy showed significantly improved dynamic segmental alignment and, to a lesser degree, spontaneous use of the upper extremity following single-event multilevel surgery compared with a comparable nonoperative control group. However, the grasp-release ability did not significantly improve in either the operative or nonoperative group.
The HandTutor and ArmTutor system is used to train patients through intensive exercise practice to use their impaired arms and hands and improve their functional movement ability.

LegTutor isolated hip, knee and ankle motor control intensive exercises provide a valuable adjunct to locomotor functional therapies

In Neurorehabil Neural Repair May 2011 http://bit.ly/hkgJCE Dr. Forrester and Macko from University of Maryland Department of Physical Therapy & Rehabilitation Science and the Baltimore Massachusetts Institute of Technology, Cambridge and Baltimore Veterans Affairs Medical Center, Baltimore USA discuss how task-oriented therapies such as treadmill exercise can improve gait velocity after stroke, but slow velocities and abnormal gait patterns often persist. This suggests that there is a need for additional strategies to improve walking. The team looked at chronic hemiparetic gait subjects trained in dorsiflexion–plantarflexion by playing functional task games during three 1-hour training sessions weekly, totaling 560 repetitions per session. The patients showed improved paretic ankle motor control along with faster and smoother movements. This resulted in increased walking velocity.
The group concludes that focus on ankle motor control may provide a valuable adjunct to locomotor therapies.
The LegTutor system trains isolated and combined hip, knee and ankle movement and focusses on leg motor control in order to improve functional walking outcome.

HandTutor system increases the dose of exercise training in order to improve functional hand movement ability

In the April edition of Neurorehabilitation and Neural Repair http://bit.ly/gXjd8x Dr. Anthony Rudd Consultant Physician in Stroke Medicine St. Thomas' Hospital London and Professor of Stroke Medicine King's College London discuss a study looking to find the optimum Dose–Response of Mobilisation and Tactile Stimulation Therapy for the Upper Extremity Early After Stroke. The group state that Physical therapy doses may need to be higher than provided in current clinical practice, especially for patients with severe paresis.
The HandTutor system allows the patient to undertake motivating and challenging active intensive exercise practice. It is suitable for patients with severe movement impairments as well as patients that need to improve their fine motor movement ability. The HandTutor system is used in acute, sub acute and outpatient treatments. The HandTutor system is also used by the patient at home and can be supported by telerehabilitation. This allows for an optimum and higher dose of exercise training.