Legtutor Joins Other Successful Post Stroke Treatments

In the journal NEUROREHABILITATION, August 29, 2011, Drs.I.A. Solopova and D.Y. Tihonova et al of the Russian Medical State University and the Central Clinical Hospital of RAS, Moscow, Russia
stated their objective: Here we developed and tested a novel system for early motor rehabilitation in acute stroke when patients are unable to stand and walk without assistance. Stepping performance may be largely facilitated by providing treatment in the supine position on a tilt table using step-synchronized functional electrical stimulation (FES) with assisted leg movements and progressive limb loading.
The methods used were: Sixty-one individuals with acute stroke were randomly assigned to two groups, experimental and control. The first group received both a conventional therapy and FES-therapy combined with progressive limb loading, whereas the control group received a conventional therapy only. Changes after treatment were assessed using clinical scores and neurophysiological measurements of movement performance.
The results were: After treatment, there was an improvement of the clinical scores, muscle forces and everyday life activity performance in both groups, however, significantly higher in the experimental group. Active rhythmic movements of the non paretic leg often provoked muscle activity in the paretic leg as well as there was a reduction of the contralateral leg muscle contraction during paretic leg movements.
The conclusion was: The developed FES and leg displacement-assisted therapy facilitates a smooth transition to walking in the vertical position and increases the patient’s functional abilities and the effectiveness of rehabilitation.
The LegTutor has been developed to improve fine motor, sensory and cognitive impairments through active exercises with augmented feedback. A specially constructed brace is placed on the affected limb and connected to a computer with dedicated software that presents challenging and motivating tasks in the form of games. The repetitive training is tailored to the patient’s performance and provides thorough documentation to allow the therapist to customize the rehabilitation program to the patient’s ability. Already in operation at leading U.S. and foreign hospitals the LegTutor together with its sister devicves (HandTutor, ArmTutor and 3DTutor) is available for adults and children alike and can be used in the home with tele rehabilitation.

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Telerehabilitation Used Successfully as a Tool for the Handtutor Armtutor Legtutor and 3DTutor

Writing in Disability Rehabilitation. Aug 25,2011 Dr.I. Cikajlo, et al of the University Rehabilitation Institute Ljubljana, Slovenia reports on the objective of telerehabilitation as a follow up to the hospital or clinic rehabilitation process in the patient’s home. The study compares the balance training in a clinical environment with the telerehabilitation approach where the physiotherapists and physicians can follow the progress remotely. In this paper, the preliminary study of the pilot project with virtual reality(VR)-based tasks for dynamic standing frame supported balance training is presented. Six stroke patients participated in the study. The patients performed the balance training for 3 weeks, 2 weeks in the clinical setting and 1 week in the home environment, five times a week, and each time for up to 20 minutes. Objective effectiveness was demonstrated by parameters as track time, number of collisions and the clinical instruments Berg Balance Scale (BBS), Timed Up & Go (TUG), 10-m walk test and standing on the unaffected and affected extremity. The outcomes were compared to the balance training group without VR and telerehabilitation support. A 2-way ANOVA was used to explore the differences between both stroke groups.
Results: In patients who were subject to VR supported balance training, the BBS demonstrated improvement of 15%, the TUG of 29%, the 10-m walk of 26%, stance time on the affected and unaffected extremity for 200 and 67%, respectively. The follow-up demonstrated that the patients preserved the gained functional improvement. The VR task performance time and number of collisions decreased to 45 and 68%, respectively. In addition, no statistical differences were found between the telerehabilitation approach with VR supported balance training and conventional balance training in clinical settings either regarding the overall mean level or regarding the mean improvement.
Conclusions: The telerehabilitation approach in VR-supported-balance-training improved balance in stroke patients and had a similar effect on the patient’s postural functional improvement as conventional balance training in clinical settings. However, when balance training is continued in the patient’s home instead of the hospital, it eventually decreased the number of outpatient visits, reduced related costs and enabled treatment of a larger number of patients.
The HandTutor, ArmTutor, LegTutor and 3DTutor have been designed to be used both in hospitals, clinics and at the patient’s home through the use of telerehabilitaion. The dedicated software gives the therapist objective and quantitative information on the patient’s functional impairment. The information is recorded and documented and allows the therapist to fully customize the treatment session–all remotely via telerehabilitation. The Tutor system is used extensively and successfully for patients suffering from brain, head, spinal, Brachial Plexus, Radial and Ulnar nerve injuries , Parkinson’s, CP, MS, Development Coordination Disorders, and more. The Tutors are adaptable to children and adults.

The Handtutor System Leads the Way in Treatment After NIH Creates Database About Better Prevention & Diagnosis

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Bethesda, Maryland
Wednesday, August 31, 2011
The National Institutes of Health announced that it is building a central database on traumatic brain injuries. The Federal Interagency Traumatic Brain Injury Research (FITBIR) database is designed to accelerate comparative effectiveness research on brain injury treatment and diagnosis. It will serve as a central repository for new data, link to current databases and allow valid comparison of results across studies.
About 1.7 million people in the United States sustain traumatic brain injuries each year from common causes such as auto accidents and falls. In addition, American Service members serving in Iraq, Afghanistan and other parts of the world face unique risks of traumatic brain injury from routine military operations, enemy fire and improvised explosive devices. According to the DoD, in the past 12 years, more than 200,000 Service members deployed worldwide have been diagnosed with traumatic brain injury, adding to the urgent need for preventive methods and treatments. Total costs of traumatic brain injury in the United States — including medical care, lost wages and other expenses — exceed $60 billion.
Treatments remain limited despite improved surgeries and rehabilitation techniques for people with brain injuries. Cases of traumatic brain injury are highly variable, involving different causes, locations within the brain and different kinds of damage to brain tissue. Such variability makes it difficult for clinicians to treat patients, predict long-term outcomes and investigate new therapies. Also, studies often report different kinds of data on patients, obtained through various tests and measures, further impeding comparison of data across studies. The FITBIR database will address these challenges by collecting uniform and high-quality data on traumatic brain injury, including brain imaging scans and neurological test results. The data will be obtained with informed consent and stripped of any patient-identifying information.
The database is expected to aid in the development of a system to classify different types of traumatic brain injury, more targeted studies to determine which treatments are effective and for whom and under what conditions. enhanced diagnostic criteria for concussions and milder injuries, predictive markers to identify those at risk of developing conditions that have been linked to traumatic brain injury, such as Alzheimer’s disease, clearer understanding of the effects of age, sex, and other medical conditions on injury and recovery, improved evidence-based guidelines for patient care, from the time of injury through rehabilitation. Reusing the database structure is expected to save 35-50 per cent of the project costs and significantly reduce the time to achieve meaningful results.
NINDS (www.ninds.nih.gov) is the nation’s leading funder of research on the brain and nervous system. The NINDS mission is to reduce the burden of neurological disease — a burden borne by every age group, by every segment of society, by people all over the world.
Already applied and being used in leading U.S. and foreign hospitals the HandTutor and its sister components (ArmTutor, LegTutor and 3DTutor) are leading the way in treatment for traumatic brain injury victims. The Tutors improve fine motor, sensory and cognitive impairments through intensive active exercises with augmented feedback. The exercises are challenging and motivating and allow for repetitive training that is tailored to the patient’s performance. The Tutors allow the therapist to customize the most suitable rehabilitation program to the patient’s ability. The system can be used by children as well as adults and are effective in the home with telerehabilitation.

LegTutor the Preferred Therapy for Post Knee Surgery

In Knee Surgery, Sports Traumatology, Arthroscopy, August, 2011 as a clinical article Lee YHD et al. reports that Allograft meniscus transplant is considered as a treatment option for meniscus–deficient patients to provide pain relief and decrease contact stress. This procedure is now considered as safe and reliable for the treatment for knee pain after total menisectomy. This is a new technique that has been developed for arthroscopic meniscus transplant with no bone blocks. It anatomically recreates the meniscus–tibial insertions and provides aperture fixation of the meniscus horns. It is an alternative to the established bone block meniscus transplant technique and is less surgically invasive.
The LegTutor together with its sister devices (HandTutor, ArmTutor and 3DTutor) has proven to be the therapy of choice in leading U.S. and foreign hospitals and clinics for post surgery therapy. The device is beneficial as well for sufferers of stroke, brain and spinal injuries, Parkinson’s disease, MS, CP and other maladys. The LegTutor is a brace that is attached to the leg of the patient and attached to a computer which has dedicated software. The program encourages the patient to move his leg in conjunction with specific games and provides an incentive to move the leg in various directions and thereby to accomplish certain tasks and speed up functional recovery.The system allows the therapist to evaluate, quantify and record the patient’s motor and cognitive impairments. The LegTutor is adjustable to any size and can be used by adults and children alike. Home bound or post recovery patients can use tele rehabiliation for the exercises.

Armtutor Effective in Post Shoulder Surgery Therapy

Writing in the Canadian Journal of Anesthesia, 08/29/2011DOI: 10.1007 Terrence L. Trentman et al states that hypotension is common in patients undergoing surgery in the sitting position under general anesthesia, and the risk may be exacerbated by the use of antihypertensive drugs taken preoperatively. The purpose of this study was to compare hypotensive episodes in patients taking antihypertensive medications with normotensive patients during shoulder surgery in the beach chair position.
Medical records of all patients undergoing shoulder arthroscopy during a 44-month period were reviewed retrospectively. The primary endpoint was the number of moderate hypotensive episodes (systolic blood pressure ≤ 85 mmHg) during the intraoperative period. Secondary endpoints included the frequency of vasopressor administration, total dose of vasopressors, and fluid administered. Values are expressed as mean (standard deviation).
The results showed that of 384 patients who underwent shoulder surgery, 185 patients were taking no antihypertensive medication, and 199 were on at least one antihypertensive drug. The antihypertensive medication group had more intraoperative hypotensive episodes [1.7 (2.2) vs 1.2 (1.8); P = 0.01] and vasopressor administrations. Total dose of vasopressors and volume of fluids administered were similar between groups. The timing of the administration of angiotensin-converting enzyme inhibitors and of angiotensin receptor antagonists (≤ 10 hr vs > 10 hr before surgery) had no impact on intraoperative hypotension.
The conclusions drawn were that preoperative use of antihypertensive medication was associated with an increased incidence of intraoperative hypotension. Compared with normotensive patients, patients taking antihypertensive drugs preoperatively are expected to require vasopressors more often to maintain normal blood pressure.
The ArmTutor with its sister devices (HandTutor, LegTutor and 3DTutor) have proven successful in post operative shoulder surgery and for patients that have suffered from brain or spinal cord injury, MS, CP, Parkinson’s amongst other disease.
The unique devices use a dedicated software that utilizes games to enhance and improve the patient’s fine motor, sensory and cognitive abilities. The ”Tutors” encourage intensive exercises and allow the therapist to gather objective and quantitative information in order to customize the treatment session. Tele rehabilitation is available for those patients that are home bound or who have recovered sufficiently to get their treatment at home. Leading U.S. and foreign hospitals and outpatient clinics now use the devices which can treat adults as well as children.

Handtutor System Aids Rehabilitation Patients with Games

Inside the physical therapy center at Banner Good Samaritan Hospital rehab patients are using unique methods for recovery.
For rehabilitation the patients are turning to video games to do their exercises and work through the pain.
“We’re actually putting them in situations where they can practice actual movements that they need to do and get that feedback they need for success,” says Therapy Services Director Kellie Johnson. “Wii-bowling by far is a favorite.”
The practice seems to be working for many patients who may have had a stroke, brain injury, spinal cord injury or that were involved in a car accident.
It’s constantly growing and now even has its own name.
“Even in rehab it’s known as wii-rehabilitation, it’s so widely used in rehab now,” says Banner Good Sam’s physical therapist Suzanne Dilly. “We have started with a new Microsoft Kinect, which is more whole body movements than just using a censor in your hand.”
The HandTutor and its sisters (ArmTutor, LegTutor, 3DTutor) compliments and adds significantly to the ‘wii rehabilitation” used currently in Banner Rehabilitation Hospital. The games used in the TuTor system include “Snowball”, an automobile race, “Asteroid Attack”, Volley Ball“, “Sky defender” and several others. These games offer challenging exercises to the patient with sensory and cognitive impairments through intensive active training. They are not only fun but also provide a thorough documentation of patient performance that allows the therapist to customize the most suitable program that fits the patient’s ability.
The devices are currently being used in leading U.S. and foreign hospitals as well as in physical therapy clinics and even in the patient’s home with tele rehabilitation.

Ness L300 Plus System follows success of the HandTuTor, ArmTutor, LegTutor and 3DTutor

Bioness Inc., today announced the commercial release of its NESS L300® Plus System. Cleared by the U.S. Food and Drug Administration (FDA) earlier this year, the L300 Plus combines the award winning NESS L300® Foot Drop System with a thigh cuff to activate even more of the nerves and muscles in the leg for greater control while walking.
The L300 Plus is intended for people living with neurological conditions resulting from stroke, multiple sclerosis, traumatic brain injury and spinal cord injury. The L300 Plus also helps to facilitate muscle re-education, prevent muscle atrophy, increase range of motion and increase local blood flow.
In addition to the L300 the HandTutor system with its sisters (ArmTutor, LegTutor and 3DTutor) has already proven itself in the treatment of joint rehabilitation for patients who have suffered from stroke, head or spinal injuries, Parkinson’s, CP, MS, Radial and Ulnar injuries, development coordination disorders, Brachial Plexus injury, post hand surgery, Complex Regional Pain Syndrome and more. The Tutor system improves fine motor , sensory and cognitive impairments through intensive active exercises with augmented feedback. The Tutors also provide a thorough documentation of patient performance and allows the therapist to customize the most suitable rehabilitation program to the patient’s ability. With the HandTutor the patient uses a unique ergonomic glove that can fit even those with neuromuscular hand problems. Powerful evaluation software gives the therapist objective and quantitative information on the impairment.
The Tutor system is currently being used in leading U.S. and foreign hospitals and clinics and can be activated from the adult or child patient’s home via telerehabilitation.

HandTutor, ArmTutor, LegTutor and 3DTutor Effective for CP Patients

Neuromuscular Rehabilitation in Manual and Physical Therapies: Principles to Practice (Principle to Practice)
Publisher: Churchill Livingstone | ISBN: 0443069697 | edition 2010 | PDF | 208 pages | 11 mb
The book starts by identifying the main unifying model/principles for motor rehabilitation (Ch. 1), including the importance of a functional approach, skill- and ability-level rehabilitation and the code for neuromuscular adaptation. The following chapters discuss several areas that are relevant to neuromuscular rehabilitation. They include how movement is organized (motor control, Ch. 2) and how it is constructed from underlying control components called motor abilities (Ch. 3). These abilities are affected in various neuromuscular and musculoskeletal conditions and may, therefore, become the target of rehabilitation. Also, proprioception plays an important role in movement control and is often affected by musculoskeletal and central nervous system damage (Ch. 4). The next important issue in rehabilitation is how to sustain the motor recovery in the long term. Chapter 5 discusses motor learning and adaptation principles and how to integrate them into the clinical management. The consequences of learning, neurophysiological/neuromuscular plasticity and adaptation are discussed in Chapter 6.3
The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.

http://handtutorblog.wordpress.com/2011/08/28/newly-developed-tutor-system-uses-telerehabilitation/

As published in J Telemed Telecare. 2011 Aug 15, 2011 Drs. D. Hailey and R. Roine et al of the School of Information Systems and Technology, University of Wollongong, Australia.
systematically reviewed the evidence on the effectiveness of telerehabilitation (TR) applications. The review included reports on rehabilitation for any disability, other than mental health conditions, and drug or alcohol addiction. All forms of telecommunications technology for TR and all types of study design were considered. Study quality was assessed using an approach that considered both study performance and study design. Judgements were made on whether each TR application had been successful, whether reported outcomes were clinically significant, and whether further data were needed to establish the application as suitable for routine use. Sixty-one scientifically credible studies that reported patient outcomes or administrative changes were identified through computerized literature searches on five databases. Twelve clinical categories were covered by the studies. Those dealing with cardiac or neurological rehabilitation were the most numerous. Thirty-one of the studies (51%) were of high or good quality. Study results showed that 71% of the TR applications were successful, 18% were unsuccessful and for 11% the status was unclear. The reported outcomes for 51% of the applications appeared to be clinically significant. Poorer-quality studies tended to have worse outcomes than those from high- or good-quality studies. We judged that further study was required for 62% of the TR applications and desirable for 23%. TR shows promise in many fields, but compelling evidence of benefit and of impact onroutine rehabilitation programmes is still limited. There is a need for more detailed, better-quality studies and for studies on the use of TR in routine care.
The HandTutor, ArmTutor, LegTutor and 3DTutor improve movement of the hand, wrist, elbow, knee, ankle, foot and other joints of the body following traumatic injuries. The devices have been effective for post stroke victims as well as for those suffering from Cerebral Palsy, spinal cord and brain injuries, Apraxia, MS, Parkinsons and other movement disabilities. The Tutors provide Intensive active exercises that reduce the rate of deterioration. The Tutors implement a rehabilitation program with augmented feedback that allows the therapist to evaluate and record the patient’s motor and cognitive impairments. Already being used in leading U.S. and foreign hospitals and clinics the system is available for children and adults and can be implemented using telerehabilitation.
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HandTutor, ArmTutor, LegTutor and 3DTutor Effective for CP Patients

Drs. HR Rostami and RA Malamiri of the D Department ofOccupational Therapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Ahvaz , Iran. have determined the effects of treatment environment (home and clinic) on results of modified constraint-induced movement therapy (modified CIMT) in children withspastic hemiplegic cerebral palsy. Method: In a single-blinded, randomized, controlled trial, 14 children with spastic hemiplegic cerebral palsy (5 females, 9 males; mean age: 74 months) received 15 hours of modified CIMT, occurring three times/week for 10 sessions every other day in two randomly assigned groups. Each session lasts one and half hours. Treatment environment for intervention group (n = 7) was home and for control group (n = 7) was clinic. Measures were conducted pre, post and 3 months after treatment period by pediatrics motor activity log and subtests 5 (upper limb coordination) and 8 (upper limb speed and dexterity) of Bruininks-Oseretsky test of motor proficiency. Sample randomization and data analysis by analysis of variance with repeated measures were conducted by SPSS-16 software in α level set at p < 0.05. Results: All subjects showed significant improvement (p < 0.01) in post-test measures except subtest 5 of Bruininks-Oseretsky test of motor proficiency. In contrast to clinic group, subjects in home showed significantly continued improvement at follow-up session in all measures. Conclusions: Modified CIMT is effective in improving upper limb function in children with spastic hemiplegic cerebral palsy. In addition, more improved performance in homepartment Drs. HR Rostami and RA Malamiri of thee group places the practice in natural context as the preferred method fortreatment of these children., The newly developed Hand, Arm, Leg and 3DTutors have proven extremely effective for therapy with Cerebral palsy patients. These innovative devices aim to optimize motor, sensory and cognitive performance to allow the patient to better perform everyday functional tasks and improve quality of life. The system uses intensive active exercises with augmented feedback. Using dedicated software the Tutors also provide objective and quantitative evaluations allowing the therapist to customize the most efficient program for the patient. Already being implemented in leading U.S. and foreign hospitals and clinics the HandTutor, ArmTutor, LegTutor and 3DTutor are available for use by children as well as adults and can be used at home via tele rehabilitation.ofOccupational Therapy, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran. have determined the effects of treatment environment (home and clinic) on results of modified constraint-induced movement therapy (modified CIMT) in children withspastic hemiplegic cerebral palsy. Method: In a single-blinded, randomized, controlled trial, 14 children with spastic hemiplegic cerebral palsy (5 females, 9 males; mean age: 74 months) received 15 hours of modified CIMT, occurring three times/week for 10 sessions every other day in two randomly assigned groups. Each session lasts one and half hours. Treatment environment for intervention group (n = 7) was home and for control group (n = 7) was clinic. Measures were conducted pre, post and 3 months after treatment period by pediatrics motor activity log and subtests 5 (upper limb coordination) and 8 (upper limb speed and dexterity) of Bruininks-Oseretsky test of motor proficiency. Sample randomization and data analysis by analysis of variance with repeated measures were conducted by SPSS-16 software in α level set at p < 0.05. Results: All subjects showed significant improvement (p < 0.01) in post-test measures except subtest 5 of Bruininks-Oseretsky test of motor proficiency. In contrast to clinic group, subjects in home showed significantly continued improvement at follow-up session in all measures. Conclusions: Modified CIMT is effective in improving upper limb function in children with spastic hemiplegic cerebral palsy. In addition, more improved performance in home group places the practice in natural context as the preferred method fortreatment of these children.
The newly developed Hand, Arm, Leg and 3DTutors have proven extremely effective for therapy with Cerebral palsy patients. These innovative devices aim to optimize motor, sensory and cognitive performance to allow the patient to better perform everyday functional tasks and improve quality of life. The system uses intensive active exercises with augmented feedback. Using dedicated software the Tutors also provide objective and quantitative evaluations allowing the therapist to customize the most efficient program for the patient. Already being implemented in leading U.S. and foreign hospitals and clinics the HandTutor, ArmTutor, LegTutor and 3DTutor are available for use by children as well as adults and can be used at home via tele rehabilitation.
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LegTutor Shows Success in Post Knee Surgery Therapy

Dr.Giles R. Scuderi, in an online publication, August 2011, reported that between May 2001 and June 2004, 388 total knee arthroplasty cases were enrolled in a prospective, randomized, multicenter investigational device exemption trial. Patients received either the investigational high-flexion mobile-bearing knee or a fixed-bearing control. At 2 to 4 years of follow-up, results in 293 patients with degenerative joint disease were compared using Knee Society Assessment and Function scores, radiographic results, complications analysis, and survival estimates. The mobile-bearing and fixed-bearing groups demonstrated similar, significant improvement over preoperative assessments in Knee Scores, maximum flexion, and range of motion. One mobile-bearing arthroplasty required revision. Radiographic results were unremarkable, and implant-related complications were rare in both groups. At this early follow-up, the investigational high-flexion mobile-bearing knee and its fixed-bearing counterpart demonstrated comparable, effective performance.
Post knee surgery physical therapy received a major boost with the advent of the LegTutor. This is a new device that improves fine motor, sensory and cognitive impairments through intensive active exercises with augmented feedback. The repetitive training is tailored to patient performance and allows the therapist to customize the most suitable rehabilitation program to the patient’s ability. The LegTutor together with its sisters the HandTutor, ArmTutor and 3DTutor are currently in use in major U.S. and foreign hospitals. Used in private clinics and even at home with tele rehabilitation the Tutors are successful for children as well as adults.

Newly developed Tutor system uses telerehabilitation

As published in J Telemed Telecare. 2011 Aug 15, 2011 Drs. D. Hailey and R. Roine et al of the School of Information Systems and Technology, University of Wollongong, Australia.
systematically reviewed the evidence on the effectiveness of telerehabilitation (TR) applications. The review included reports on rehabilitation for any disability, other than mental health conditions, and drug or alcohol addiction. All forms of telecommunications technology for TR and all types of study design were considered. Study quality was assessed using an approach that considered both study performance and study design. Judgements were made on whether each TR application had been successful, whether reported outcomes were clinically significant, and whether further data were needed to establish the application as suitable for routine use. Sixty-one scientifically credible studies that reported patient outcomes or administrative changes were identified through computerized literature searches on five databases. Twelve clinical categories were covered by the studies. Those dealing with cardiac or neurological rehabilitation were the most numerous. Thirty-one of the studies (51%) were of high or good quality. Study results showed that 71% of the TR applications were successful, 18% were unsuccessful and for 11% the status was unclear. The reported outcomes for 51% of the applications appeared to be clinically significant. Poorer-quality studies tended to have worse outcomes than those from high- or good-quality studies. We judged that further study was required for 62% of the TR applications and desirable for 23%. TR shows promise in many fields, but compelling evidence of benefit and of impact onroutine rehabilitation programmes is still limited. There is a need for more detailed, better-quality studies and for studies on the use of TR in routine care.
The HandTutor, ArmTutor, LegTutor and 3DTutor improve movement of the hand, wrist, elbow, knee, ankle, foot and other joints of the body following traumatic injuries. The devices have been effective for post stroke victims as well as for those suffering from Cerebral Palsy, spinal cord and brain injuries, Apraxia, MS, Parkinsons and other movement disabilities. The Tutors provide Intensive active exercises that reduce the rate of deterioration. The Tutors implement a rehabilitation program with augmented feedback that allows the therapist to evaluate and record the patient’s motor and cognitive impairments. Already being used in leading U.S. and foreign hospitals and clinics the system is available for children and adults and can be implemented using telerehabilitation.

http://handtutorblog.wordpress.com/2011/08/25/armtutor-successful-in-post-shoulder-therapy/

Dr. Kiyohisa Ogawa writing in the Journal of Trauma-Injury Infection & Critical Care, 17 August 2011 explains that the majority of type I coracoid fractures set out in Ogawa’s classification constitute double disruption of the superior shoulder suspensory complex (SSSC) as proposed by Goss, frequently resulting in healing delay and adverse functional consequences. However, there are few reports alluding to strategies or concrete treatment methods of such injuries. The purpose of this report is to introduce our surgical strategy for treating the type I coracoid fracture with concurrent injuries and to describe our treatment method with their outcomes.
The methods used: Thirty-six patients, who had acute type I coracoid fractures surgically treated and were followed up for 1 year or longer, constituted the present study population. Reduction and stabilization were undertaken beginning with the most medial unstable injury of SSSC and proceeding to the lateral ones. The respective coracoid fractures were finally reduced and fixed. In the follow-up, patients were directly examined and evaluated using the ratios of the Constant score for the injured side to that for the normal side.
The results were: There were a total of 80 ipsilateral injuries of SSSC, including the coracoid fractures, and double disruption accounted for 94% of the patients. Of these, 62 injuries were surgically treated. No complications associated with surgery were observed. Bone union was achieved in all fractures; no patients required an additional operation. The Constant score ratio at the follow-up was 93% +/- 7.4% on average.
The conclusionwas : Although the majority of cases with type I coracoid fractures suffered double disruptions of SSSC, satisfactory results have been obtained with surgical treatment focusing on the assured reconstruction of a firm scapuloclavicular union.
Following shoulder surgery as well as other traumas the ArmTutor has proven to be a success in improving fine motor, sensory and cognitive impairments through intensive active exercises. Repetitive training tailored to the patient’s performance includes augmented feedback leading to enhanced functional rehabilitation. The ArmTutor and its sister devices the HandTutor, LegTutor and 3DTutor are being used in leading U.S. and foreign hospitals and clinics. The system is adaptable to both children and adults and allows for tele rehabilitation for patients at home.

HandTutor Successful in Post Surgery Therapy

Dr. J.Singh et al. writing in
Indian Journal of Orthopaedics, 08/23/2011http://upload.wikimedia.org/wikipedia/commons/6/63/2006_Italy_voting_hand.jpg
states that conservative treatment is an inexpensive method, particularly suitable for stable fractures, and in patients who are poor candidates for surgery. Surgical modalities have a distinct advantage of stable fixation, but with added risk of digital stiffness. Percutaneous pinning is a reliable, most commonly used surgical modality and technically easier. Both conservative and surgical modalities have good efficacy when used judiciously. When indicated for physical therapy following surgery the HandTutor together with its sisters ArmTutor, LegTutor and 3dTutor have proven successful in rehabilitating finger and wrist mobility. The new devices use dedicated software and can record the patient’s motor and cognitive impairments which the therapist can then assist the patient in improving the range of motion, the accuracy and speed of movement as well as the cognitive function of the affected joint. The HandTutor comes in varying sizes and thus is suitable for children as well as adults. Hospitals, clinics and, with tele rehabilitation, the patient’s own home are the settings for this innovative system.

ArmTutor Assists in Enhanced Rehabilitation following Arthrodesis Surgery

In a study of Poliomyelitis in children which can cause paralysis of shoulder girdle muscles leading to a flail shoulder, Joshua D. Miller, MD et al, in the Journal of Pediatric Orthopaedics:, September 2011 - Volume 31 - Issue 6 - p 679–682, stated that shoulder arthrodesis is indicated as a possible treatment for these children in order to stabilize the shoulder. This retrospective study reviewed all shoulder arthrodesis surgeries owing to complications of polio performed at a major medical institution between 1981 and 1996 to assess position of fusion, radiographic evidence of fusion, complications, and patient satisfaction., Methods: A review of medical records identified 11 patients undergoing 13 shoulder arthrodesis procedures, with a mean age of 14.7 years at the time of the procedure. Internal fixation was achieved with large cancellous screws in 8 patients and a Dynamic Compression Plate (DCP) plate in 5 procedures. Average follow-up period was 41 months. Eight patients were placed into a spica cast and 5 used a sling postoperatively., The results showed that shoulder arthrodesis surgery in this cohort resulted in an average position of fusion with 42.3 degrees of abduction, 23.8 degrees of flexion, and 26.2 degrees of internal rotation. Twelve of the 13 procedures assessed for radiographic union demonstrated fusion. The most common complications were malrotation and nonunion. Of the 13 procedures, 2 underwent humeral osteotomies for malrotation, and 1 with 6.5 mm cancellous screws required revision with a DCP plate owing to nonunion. Six patients underwent hardware removal, 3 of which were specifically owing to complaints of painful hardware. At final follow-up, no patient reported pain and all expressed satisfaction with their results and improved shoulder function after repair.His conclusion was that this study is the largest series of shoulder arthrodesis surgeries for treatment of patients with a flail shoulder from polio to date, providing a more thorough analysis of its efficacy as an indicated treatment., The ArmTutor together with its sister devices (HandTutor, LegTutor, 3DTutor) has proven very effective in improving range of motion of shoulders and elbows following surgery, disease or trauma. The innovative device is an electronic brace connected to a computer with dedicated software. It allows for repetitive exercises to the affected joint with augmented feedback. Currently used in leading U.S. and foreign hospitals the system can be administered by a physical therapist or the patient himself. It is available for children as well as adults and can be used together with tele rehabilitation.

ArmTutor Assists in Enhanced Rehabilitation Following Elbow Fractures

ArmTutor Assists in Enhanced Rehabilitation Following Elbow Fractures

Posted August 21, 2011 by handtutorblog in Hand Tutor. Tagged: armtutor, Elbow, joint rehabilitation, Physical therapy, Upper limb. Leave a Comment | Edit
Elbow - coude

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According to Dr. P. Harding at the Department of Physiotherapy, The Alfred Hospital in Melbourne, Australia and published in Cochrane Database Syst Rev. 2011 http://1.usa.gov/nes7Ge, there is a lack of robust evidence to inform on the timing of mobilization, and specifically on the use of early mobilization, after non-surgical or surgical treatment for adults with elbow fractures. There is a need for high quality, well-reported, adequately powered, randomized controlled trials that compare early versus delayed mobilization in people with commonly occurring elbow fractures, treated with or without surgery. Trials should use validated upper limb function scales, and assessment should be both short-term and long-term (at least one year). The ArmTutor has been developed to afford the patient intensive computer assisted training to regain full mobility of the elbow and limb. The sensor fitted device, one of several (HandTutor, LegTutor and 3DTutor) is placed on the arm and and connected to a computer with dedicated rehabilitation software that encourages intensive exercises to enhance a full range of mobility.

HandTutor proven successful for self management, joint protection and exercises in hand osteoarthritis

In the July issue of BMC Musculoskeletal Disorders http://www.ncbi.nlm.nih.gov/pubmed/21745357 Dr. Dziedzic and his group from Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom discuss their plan to assess self management, joint protection and exercises in hand osteoarthritis: a randomized controlled trial with cost effectiveness analyses.

The main analysis will be on an intention to treat basis and will assess the clinical and cost effectiveness of joint protection and hand exercises for managing hand osteoarthritis (OA). The findings will improve the cost–effective evidence based management of hand OA.

Methods

Participants aged 50 years and over registered at three general practices in North Staffordshire and Cheshire will be mailed a health survey questionnaire (estimated mailing sample n=9,500). Those fulfilling the eligibility criteria on the health survey questionnaire will be invited to attend a clinical assessment to assess for the presence of hand or thumb base OA using the ACR criteria. Eligible participants will be randomised to one of four groups: leaflet and advice; joint protection (looking after your joints); hand exercises; or joint protection and hand exercises combined (estimated n=252). Results The primary outcome measure will be the OARSI/OMERACT responder criteria combining hand pain and disability (measured using the AUSCAN) and global improvement, 6 months post–randomisation. Secondary outcomes will also be collected for example pain, functional limitation and quality of life. Outcomes will be collected at baseline and 3, 6 and 12 months post–randomisation. The main analysis will be on an intention to treat basis and will assess the clinical and cost effectiveness of joint protection and hand exercises for managing hand OA.

The HandTutor is an motion capture glove which together with dedicated rehabilitation software motivates patients to do intensive finger(s) and wrist exercises. It is important that patients suffering form joint degenerative diseases continue to do active exercises in order to reduce the rate of movement and musculoskeletal degeneration. The ArmTutor which allows for customized shoulder and elbow exercises and the LegTutor that allows for customized knee and hip exercises have also been proven to reduce the rate of joint movement degeneration in OA.

The HandTutor, ArmTutor, LegTutor and 3DTutor are used in many clinics in the USA and worldwide with patients are also using these devices in private outpatient clinics and the home environment. Home bound patients can use tele rehabilitation that is supported by physical and occupational therapists.

LegTutor, 3DTutor improves patient's functional balance ability

In the August 2011 edition of Phys Ther Dr. Szturm and his team from Department of Physical Therapy, School of Medical Rehabilitation, University of Manitoba Canada studied compared traditional physical therapy balance exercises with dynamic balance exercises coupled with video game play. A study was conducted on a group of 30 community-dwelling and ambulatory older adults in a geriatric day hospital environment. Dr. Szturm group found that there was greater improvement in dynamic standing balance control in the video game play group compared with the typical exercise program.

The LegTutor and 3DTutor are wearable motion sensor devices that use dedicated rehabilitation software. This allows patients to perform active intensive lower extremity hip, knee and balance exercises customized to their movement ability in a motivating environment. Physical therapists in major rehabilitation centers worldwide have been using the LegTutor and 3DTutor as a tool for improving the patients functional balance ability.