CP Patients Benefit From Tutors in Physical Therapy

Simon Martin reporting in YORK REGION.COM on September 17, 2011 relates the following story.
Life was going according to plan for Dana and Jared Florence in 2008.
They had good careers and it was a natural step to add a child to the mix. So it was a bit shocking when Ms Florence found out she was having triplets. It was even more earth shaking when they were born 15 weeks premature.
The Florences’ lives had been turned upside down.
In the beginning, it was 50-per-cent chance of survival, Ms Florence said.
“The first few months, it was day by day.”
The triplets — Taylor, Cole and Brody — were discharged from hospital at different times. It was only after six months in intensive care that the babies were all home with their parents.
“It was a difficult time,” she said. “All the things I thought I would experience were different. I would have to wash my hands before touching my own baby.”
Once at home, it became clear the triplets weren’t developing at the rate expected of them. At 10 months, all three was diagnosed with cerebral palsy — a brain condition with no known cure.
But their challenges fuelled the couple’s desire to do something to make a difference for children such as their own.
“We were looking for more in terms of what was happening with research,” she said.
They created Three To Be to help support child neurological disorders research and the response has been fantastic, Ms Florence said.
The organization hosted its second annual Stems of Hope Gala Saturday at Toronto’s Kool Haus and is optimistic it surpassed last year’s total.
Last year, the gala raised more than $500,000, with proceeds going to stem cell research at Toronto’s Hospital for Sick Children and programs at Holland Bloorview Kids Rehabilitation Hospital.
This year, the group raised enough to purchase the Paediatric Lokomat Pro for Holland Bloorview, which is piece of equipment that has the potential to help teach children to walk.
The Barenaked Ladies, Alex Bilodeau and Alexander Richards were just some of the celebrities on hand.
“[Three To Be] has become so much bigger than we could have ever imagined,” Ms Florence said.
Ms Florence grew up in Thornhill and was part of the first graduating class from Westmount Collegiate Institute. The community has really gotten behind the cause, she said, noting her parents still live in Thornhill.
Ms Florence, who now lives in Toronto, said her children mean the world to her.
“It has been such a journey. They are the most beautiful, smart, inspiring people I have ever met,” she said.
The HandTutor, ArmTutor and LegTutor have been instrumental in augmenting functional movement for patients suffering from Cerebral Palsy and other debilitating diseases that affect the joints. Children such as the Florences can enjoy the various games programmed into the dedicated software.
The system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. Controlled exercise practice will help to prevent the development of compensatory movement patterns. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. In addition the therapist can objectively and quantitatively evaluate and report on the treatment progress. The rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows the patient to better perform everyday functional tasks to improve their quality of life. The Tutor system is FDA and CE certified.

ArmTutor a Boon to Pitcher’s Success

Ryan Christopher DeVault writing for Yahoo online Sepember 2011 stated that it looks like the Washington Nationals are going to try very hard to protect the career of Stephen Strasburg. The franchise is going to limit the number of innings he gets in 2012, all in a plan to try and ease his arm back into things following reconstructive surgery.
According to ESPN, the organization hasn’t quite figured out how many innings he will have to work with next year. General manager Mike Rizzo stated, “I’ve already calculated it, semi-calculated it, in my mind with our medical staff and our pitching people. We’ve already discussed it.”
It’s very understandable that Washington would want to protect one of the two best assets that the franchise has (the other is Bryce Harper(notes)). Towards the end of the 2010 season, Strasburg was feeling arm weakness, and he ended up having a ligament-replacement operation that kept him off the mound for nearly nine months. He recently returned to the starting rotation for Washington to give him a few innings before the season comes to an end.
In four starts this year, Strasburg is 0-1 with a 2.00 ERA. He has only pitched past the fifth inning one time, though, mostly because he has been on a strict pitch count. That game came against the Florida Marlins on Sept. 17 when he went six innings while giving up just one run on four hits. He has pitched 18 innings total, striking out 14 and walking no batters. That last statistic really shows how great his control has been, even if he is just getting back into the flow of things.
In parts of two seasons, Strasburg has only been able to start 16 games, but he has won five of them and posted an impressive ERA of just 2.72. He has 106 total strikeouts in just 86 innings, many of which came in 2010 in several high-profile starts. Everything points toward him being a star at some point if he can simply stay healthy, and that is exactly what everyone in the franchise and the fan base of Washington wants to take place.
When the season comes to an end, the front office will probably sit down with Strasburg and figure out how he feels about his performance so far this year. If he is still feeling great, the number of innings he is given next year might be a lot higher than if he is worn out. At that point, the team might decide it is time to announce it to the fan base.
With the regular use of the ArmTutor, patients like Strasburg can improve the agility and range of movement of their injured arm.
The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The ArmTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The ArmTutor™ allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multijoints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The ArmTutor™ with its sister devices (HandTutor, LegTutor and 3DTutor) system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.
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ArmTutor Effective for Upper Extremity Therapy

Inge-Marie Velstra, MSc, OT etal writing in PM&R on September 2011 provides information regarding the (1) responsiveness and reliability of different outcome measures used with persons who have impairments in upper extremity function and (2) their content validity based on the International Classification of Functioning, Disability, and Health (ICF).
MEDLINE, CINAHL, PsycINFO, and EMBASE databases were systematically searched for studies on outcome measures used to evaluate upper extremity function; only studies written in English and published between July 1997 and July 2010 were considered.
One investigator reviewed titles and abstracts of the identified studies to determine whether the studies met predefined eligibility criteria (eg, study design, age <18 years). Another investigator did the same for 70% of the studies.
All types of outcome measures in the included studies were extracted, and the information retrieved from these outcome measures was linked to the ICF by 2 independent investigators who used standardized linking rules. In addition, studies reporting the clinical responsiveness, interrater reliability, and test-retest reliability of the outcome measures were identified.
From among the 894 studies that were included in this review, 17 most frequently used outcome measures in the different study populations were identified. Five were patient-reported outcome measures and 12 were clinical outcome measures. The outcome measures show large variability with regard to the areas of functioning and disability addressed. Reliability and responsiveness data are missing for a few outcome measures or for certain populations for which they have been used.
This systematic review provides an overview of the outcome measures used to address functioning and disability as they are related to the upper extremity. The results of this study may help clinicians and researchers select the most appropriate outcome measure for their clinical population or research question according to ICF-based content validity, and additional information on the reliability and responsiveness of the measures is provided. Our findings also can provide directions for further research.
The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The ArmTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The ArmTutor™ allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multijoints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The ArmTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

Tutor System an Important Therapy Tool for TBI recovery

On September 27, 2011 in Stock Markets Review.com data was published that the
U.S. Centers for Disease Control and Prevention (CDC) declared that approximately 1.7 million people suffer traumatic brain injury each year. Many of these injuries happen as a result of auto accidents. A traumatic brain injury is a serious health concern and, in many cases, requires a lifetime of rehabilitative training for sufferers.
Traumatic brain injury (TBI) can occur when a person receives a hit or blow to the head, is involved in sudden acceleration or deceleration, or suffers a penetrating injury to the head. In instances of impact or sudden changes in speed, the brain may slam into the interior of the skull, damaging delicate brain tissue.
The extent of a TBI can range from mild to severe. Mild TBI, like a concussion, for example, is usually temporary with no long-term health consequences. However, severe TBI can lead to permanent and serious health complications. The Centers for Disease Control (CDC) reports that about 75 percent of TBIs are classified as mild; however many TBI sufferers are severe requiring extensive hospitalization, some even die.
Sometimes called the “silent epidemic,” TBI’s can occur without outward signs of damage. Jonathan Lifshitz, assistant professor at the University of Kentucky Chandler Medical Center’s Spinal Cord and Brain Injury Research Center, says many people with TBI are “walking wounded” and suffer from injuries deemed serious but not easily observable.
When TBI occurs, emergency care and surgery is often necessary, followed by medication, therapy and cognitive rehabilitative training. Keith Cicerone, director of neuropsychology at New Jersey’s JKF Johnson Rehabilitation Institute, states that TBI can cause permanent changes in mental processing, including slowed thinking, dulled attention, memory problems and impaired judgment. For these reasons, prompt and proper medical attention is essential when someone may have suffered a brain injury, even if he or she appears to have just suffered a bump on the head.

When TBI occurs and recovery is progressing the Tutor system (HandTutor, ArmTutor, LegTutor, 3DTutor) has shown much success in rehabilitation of joint movement. The Tutor system consists of ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients in rehabilitation centers, private clinics and the home where it can be supported by telerehabilitation. It is designed for those who have head, trunk, upper and lower extremity movement dysfunction.
The system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. Controlled exercise practice will help to prevent the development of compensatory movement patterns. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. In addition the therapist can objectively and quantitatively evaluate and report on the treatment progress. The rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows the patient to better perform everyday functional tasks to improve their quality of life. The Tutor system is FDA and CE certified.

ArmTutor Augments Parkinson’s Symptom Exercise Therapy

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In a post on Monday, September 26, 2011 Ankit Ajmera reported the following story in The Mumbai Mirror:
The day before we met Anand Sagar of Sagar Arts, he woke up at 6 am to fly to Baroda, attended a series of meetings and flew back to Mumbai in the evening. For most of us, a hectic day is part and parcel of Mumbai life. However for 70-year-old Anand, it’s an everyday battle and he won it well that one day. Anand, the co-director of the Ramayana TV series, suffers from Parkinson’s disease, a degenerative disorder of the nervous system which affects bodily control resulting in movement difficulties, muscular stiffness and constant tremors. A person suffering from Parkinson’s feels like a rope has been tightly wound over his/her body and it tightens with every passing day.
Eventually, a seemingly effortless task such as lifting up a glass of water feels like moving a mountain.
Most Parkinson’s patients are rendered speechless and motionless with the gradual progression of the disease. But not Anand. He parties, has a drink or two, snorkels and works every day.
He has been able to reverse the symptoms, not the disease, and outwardly, looks like a healthy person. His two weapons are — His tireless devotion to exercise and a rare surgery that installed a battery-operated pacemaker inside his brain that facilitates muscle co-ordination.
The Deep Brain Stimulation technique, as it is called, reduces stiffness and rigidity in his limbs, but a lot depends on Anand flexing his muscles daily. If he doesn’t the symptoms get stronger the next day.

He decided to go in for the surgery this March and is still recovering. The long period of rest has affected his stamina. He walks for three kilometres a day and his target is to hit six. Exercise plays large part in his well-being and recent research shows that it protects the remaining dopamine-producing nerve cells, helping them work better and survive for longer.
There is a possibility that regular exercise could slow down the progression of Parkinson’s, improving the quality and life-span of a patient. Anand has to do flexing exercises for each little muscle.

Dr Anandh Balasubramaniam, the doctor who operated on Anand commends his dedication to exercise, “His well-being is activity dependent. If he stops walking, doing his daily flexing exercises, he will go back to the wheelchair.”
The ArmTutor™ has been in the forefront of slowing progression of Parkinson’s disease symptoms and has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up.
The ArmTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice. The ArmTutor™ allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multijoints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The ArmTutor and its sister devices (HandTutor, LegTutor and 3DTutor) are being used successfully in leading U.S. and foreign hospitals and clinics. Through the use of telerehabilitation the Tutors are available for home use.

3DTutor Assists in Drop Foot Therapy

Scientists in the Netherlands are using robotic legs to try to improve the movement of stroke patients.
The prototype device is called the Lower-extremity Powered ExoSkeleton, or LOPES, and works by training the body and mind of a patient to recover a more natural step.
The machine is also being tested on spinal injury patients who have recovered some restricted movement in their legs.
LOPES has been developed by engineers at the University of Twente in Enschede in the Netherlands over several years. Designed for the rehabilitation clinic, it is not a mobile device but supports the patient as they walk on a treadmill.
It can do all the walking for the patient, or it can offer targeted support in either one leg or with one element of the walking process. The machine can also detect what the patient is doing wrong.
Petra Hes is one of those testing the device. She suffered a stroke aged just 17. Years of physiotherapy have helped, but she still has what is known as a “drop foot”, which means she cannot lift and flex her left foot in the way she once did, or even remember how to do so.

The 3DTutor™ is a motion feedback device that can be helpful for ”drop foot” syndrome as well as other dysfunctions. It is positioned on various parts of the body. For example, the 3DTutor™ provides motion feedback on the supination and pronation position of the forearm and the trunk movement position when positioned on the forearm and the trunk. When combined with the ArmTutor™ and the HandTutor™ the 3DTutor™ allows the Tutor system to evaluate and treat the whole upper extremity by providing multijoint virtual functional task exercises of the arm and feedback on the patient’s trunk position. When combined with the LegTutor™ and positioned on the ankle, the 3DTutor™ contributes to the complete lower extremity multijoint evaluation and virtual functional task exercises of the hip, knee and ankle.

Brain Injury Victims Benefit from Tutor Therapy

Don Walker reporting in the Journal Sentinel Sept. 22, 2011 comments about Justin Greenwood who, just eight years ago, was on the kickoff team for the University of Wisconsin-Eau Claire Blugolds.
A four-sport star in high school in Park Falls, Greenwood, wearing No. 42, had come to Eau Claire to play outside linebacker. A junior, Greenwood and his fellow Blugolds were playing UW-River Falls in River Falls.
“It was on a kickoff. I was running down, took a little hit, a mild hit from the side. I got up and I started to lose consciousness. I just started walking off the field and collapsed on the sideline,” he said.
“He was the wedge-breaker for us on kickoffs,” recalled Nels Fredrickson, the team’s quarterback. “He came up to me and said, ‘What the heck happened to me?’ And then he just fell down.”
His mother, Glenda, was in the stands.
“I wasn’t watching the kickoff,” she said. “All of a sudden he ran off the field. We only had 10 guys on the field. I was watching him on the sidelines. He was squatting down. He was putting his hands on his head. He was losing consciousness, I think.”
His mother, sensing something was wrong, hopped the fence and went to the field. “They had to call an ambulance. He was turning blue. They said to me, ‘Well, it’s cold out.’ I was watching his every move. His brain was swelling, and it was closing off his air passages.”
Greenwood was intubated. Eventually, he was flown by helicopter to the Twin Cities for treatment, rehabilitation and therapy.
It has been a long, hard road for Greenwood, now 30, and his mother.
Greenwood left school, never to return. He can’t drive a car. He has short-term memory problems. When he watches a movie on television, he’ll forget most of it afterward.
He wears special glasses that help him with side-to-side vision.
“When he gets excited, he talks faster,” his mother said. “He has to take a deep breath and slow down. But he’s had to overcome a lot of obstacles. His life is not the same.”
“I can’t do what I want,” Greenwood said. “It’s about acceptance at this point.”
Greenwood is not alone. According to the Brain Injury Association of Wisconsin, an estimated 1.7 million children and adults in the U.S. sustain a traumatic brain injury and another 795,000 individuals sustain an acquired brain injury from non-traumatic causes each year. Currently, more than 3.1 million children and adults in the U.S. live with a lifelong disability as a result of traumatic brain injury and an estimated 1.1 million have a disability due to stroke, according to the association.
Unfortunately brain and spinal cord injury is very debilitating however when the HandTutor, ArmTutor, LegTutor and 3DTutor is introduced to physical rehabilitation programs for those and many other indications, patient improvement is recognized in a relatively short time.
The HandTutor, ArmTutor, LegTutor and 3DTutor are devices that are FDA and CE certified and are being used in leading U.S. and foreign hospitals. They have had success in improving 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. Intensive active exercise can reduce the rate of deterioration and this is what the ”Tutor” devices provide.
The system is also used in physical therapy clinics as well as the patient’s home with tele rehabilitation. The ”Tutors” are suitable for adults and children.

Therapeutic Exercise and Joint Mobilization Strengthned by Tutor System

Dr. Tracy J. Brudvig,etal of the MGH Institute of the Massachusetts General Hospital pooled and summarized the published research evidence examining if the combination of therapeutic exercise and joint mobilization is more beneficial than therapeutic exercise alone in patients with shoulder dysfunction. Their findings were published in J Orthop Sports Phys Ther, Epub 4 September 2011.
They conducted a systematic review with meta-analysis. Therapeutic exercise is an effective intervention for patients with shoulder dysfunction which is often supplemented by joint mobilization techniques. Numerous studies have examined the effects of the combination of therapeutic exercise and joint mobilization on patients with shoulder dysfunction.they used Six data bases that were searched for randomized controlled trials (RCTs). All RCTs published in English studying the effectiveness of therapeutic exercise and joint mobilization on adults having either clinically or radiographically confirmed shoulder dysfunction resulting in pain, restriction of range of motion (ROM), and/or limitation in function were included in this review. Effect size was calculated in the form of standardized mean difference (SMD) with 95% confidence interval (CI) for each variable and then combined to represent weighted standardized mean differences (WSMDs) and 95% CIs.

The results they received were that even studies that met the inclusion criteria were identified with a total of 290 participants. The WSMDs and CIs which combined the results of all the studies for a particular variable revealed equivocal results for all variables. The resulting WSMDs and 95% CIs were as follows; 0.2 (95% CI: -0.68, 1.08) for pain, 0.15 (95% CI: -0.67, 0.97) for abduction ROM, -0.04 (95% CI: -0.65, 0.57) for flexion ROM, 0.01(95% CI: -0.79, 0.81) for internal and external rotation ROM, and 0.09 (95% CI: -0.46, 0.64) for function and disability. Even after elimination of sources of heterogeneity, the new WSMDs and CIs continued to overlap zero giving equivocal results.
They drew the conclusion that the current evidence is inconclusive with respect to the beneficial effects of the combination of therapeutic exercise and joint mobilization versus therapeutic exercise alone for reducing pain, increasing ROM and function, and limiting disability in patients with shoulder dysfunction.
The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy for shoulder and other joint therapies. 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.

Tutor System an Indispensible Part of SCI Physical Therapy

It was revealed in a PRESS RELEASE on Sept. 23, 2011 that the U.S. Health Care System Doesn’t Meet Needs of Patients With Spinal Cord Injury.
New research highlights disparities in access for patients and lack of awareness about spinal cord injury by health care providers
Several studies in the current issue of Topics of Spinal Cord Injury Rehabilitation put a needed spotlight on the health and health care disparities experienced by individuals with spinal cord injury. This research highlights the disparities in access for patients and lack of awareness about SCI by health care providers.
“We health care providers can do a better job of dealing with health and health care disparities related to individuals with spinal cord injury, if we are better informed as to how and where the disparities occur,” says Michelle A. Meade, Ph.D., assistant professor in the University of Michigan Medical School’s Department of Physical Medicine and Rehabilitation, and guest editor for the issue, which published this week.
U-M faculty wrote or co-authored several articles on the issue.
An article written by Lisa DiPonio, M.D., assistant professor, and Randy S. Roth, Ph.D., professor, both with the U-M Department of Physical Medicine and Rehabilitation and the VA Ann Arbor Healthcare System, and several colleagues, highlights how Emergency Room providers might not have the knowledge to effectively treat individuals with chronic SCI. Conclusions were based on a survey of how familiar emergency medicine physicians were with SCI medicine and their responses to clinical vignettes about patients with SCI receiving critical care.
In an article about women with violently acquired SCI, Meade and her colleague Martin Forchheimer, MMP, also with the U-M Department of Physical Medicine and Rehabilitation, describe this vulnerable population and compare them to other women with SCI and men with violently acquired SCI.
Another article outlines the extent of the challenges that individuals with SCI face and lays out potential solutions to better meet the ongoing post-rehabilitation health care needs of people with SCI. Access to timely and appropriate health care is vital to the well-being of individuals with SCI, and they often have problems obtaining the kinds of health services they need when they need them.
There are approximately 265,000 people living with traumatic SCI in the U.S. More than 40 percent are the result of motor vehicle crashes, 27.9 percent are the result of falls, 15 percent from interpersonal violence and 8 percent from sports injuries. There are approximately 12,000 new cases of SCI in the U.S. each year.
Damage to the spinal cord can result in a loss of function that impacts the central, peripheral and autonomic nervous systems. The extent of impact depends on the degree and level of injury, which determines what muscles and functions might be affected. Individuals with SCI range in ability from those with high level or “complete” tetraplegia who require a ventilator to breathe, to individuals with incomplete paralysis who may be able to walk.
When SCI results in at least partial paralysis the HandTutor, ArmTutor, LegTutor and 3DTutor play an important part of the recovery process.
The Tutor system is a group of newly developed devices that are FDA and CE certified and are being used in leading U.S. and foreign hospitals. They have had success in improving movement of the hand, wrist, elbow, knee, ankle, foot and other joints of the body following traumatic injuries. The devices have been effective for spinal cord and brain injuries, stroke victims as well as for those suffering from Cerebral Palsy, Apraxia, MS, Parkinsons and other movement blocking disabilities. Intensive active exercise can reduce the rate of deterioration and this is what the ”Tutor” devices provide.
The system is also used in physical therapy clinics as well as the patient’s home with tele rehabilitation. The ”Tutors” are suitable for adults and children.

HandTutor Significant Part of Upper Limb Rehabilitation Program

In an article entitled “Feasibility and efficacy of upper limb robotic rehabilitation in a subacute cervical spinal cord injury population” published in Spinal Cord , (13 September 2011)
Drs. J Zariffa, N Kapadia, J L K Kramer,etal wrote that the objectives of the study were to investigate the use of an upper limb robotic rehabilitation device (Armeo Spring, Hocoma AG, Switzerland) in a subacute cervical spinal cord injury (SCI) population.
Two Canadian inpatient rehabilitation centers were used in this study and twelve subjects (motor level C4–C6, ASIA Impairment Scale A–D) completed the training, which consisted of 16.1±4.6 sessions over 5.2±1.4 weeks. Two types of outcomes were recorded: (1) feasibility of incorporating the device into an inpatient rehabilitation program (compliance with training schedule, reduction in therapist time required and subject questionnaires) and (2) efficacy of the robotic rehabilitation for improving functional outcomes (Graded and Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), action research arm test, grip dynamometry and range of motion).
By the end of the training period, the robot-assisted training was shown to require active therapist involvement for 25±11% (mean±s.d.) of the total session time. In the group of all subjects and in a subgroup composed of motor-incomplete subjects, no statistically significant differences were found between intervention and control limbs for any of the outcome measures. In a subgroup of subjects with partial hand function at baseline, the GRASSP-Sensibility component showed a statistically significant increase (6.0±1.6 (mean±s.e.m.) point increase between baseline and discharge for the intervention limbs versus 1.9±0.9 points for the control limbs).
The conclusion they drew was that the pilot results suggest that individuals with some preserved hand function after SCI may be better candidates for rehabilitation training using the Armeo Spring device.
When there is partial hand function or some preserved hand function the HandTutor has shown progress in returning normal movement to the affected joint. The HandTutor™ system is an active exercise based hand rehabilitation program that uses the accepted methods of impairment oriented training (IOT) with augmented feedback. The HandTutor™ evaluates and treats finger and hand movement dysfunction through exercises that encourage extension/ flexion of the finger(s) and wrist.
The HandTutor™ system consists of a safe comfortable glove, with position and speed sensors that precisely record finger and wrist motion, and dedicated rehabilitation software. The ergonomic gloves come in five sizes for both right and left hands. The system, used for upper limb rehabilitation from spinal cord and brain injuries and other disabilities, employs the known concept of biofeedback to give occupational and physical therapists access to an affordable user friendly hand rehabilitation package. The HandTutor™ can also be used in combination with the 3DTutor™ for arm rehabilitation. The devices are used extensively in inpatient rehabilitation programs as well as clinics and even at home through tele rehabilitation. The HandTutor™ is CE medical and FDA certified.

HandTutor Adaptable to Children’s Physical Therapy Needs

The Journal of Pediatric Orthopaedics: October/November 2011 – Volume 31 – Issue 7 features the results of a study conducted by Samuel Kunkel MS,
Emily Eismann MS and Roger Cornwall MD. They state that despite the frequency of hand and wrist injuries in children, patient-reported outcomes have not been systematically assessed. This study hypothesizes that the Pediatric Outcomes Data Collection Instrument (PODCI) can be reliable, responsive, and discriminatory in assessing the impact of acute pediatric hand and wrist injuries on function and quality of life.Consecutive patients presenting to a pediatric clinic with acute hand and wrist injuries over a 3-month period completed PODCI questionnaires at initial and follow-up visits. Reliability was assessed with Cronbach α and responsiveness with standardized response means and effect sizes. Scores for each PODCI scale were compared with established age-matched normative scores and among injury types, injury locations, sexes, age groups, and visits using t tests. Changes in clinic wait times, visit lengths, and patient satisfaction were assessed as measures of feasibility through tests and Fisher exact tests. The influence of PODCI administration on patient wait times, total visit lengths, and satisfaction was measured through t tests and Fisher exact tests.
The results found were that during this study, 125 patients with acute hand and wrist injuries completed PODCI questionnaires at initial presentation. Follow-up questionnaires were collected at a median of 3 weeks later from 22 patients. All PODCI scales demonstrated internal reliability and responsiveness to clinical change in this sample. At the initial visit, mean scores for all PODCI scales, except happiness, were significantly lower than established age-matched normative values. Adolescents had worse pain and global function than young children. Children significantly improved in mobility, comfort, and global function from initial visit to follow-up. At follow-up, young children were similar to norms on all scales except global function, whereas adolescents were only similar to norms on pain. PODCI administration did not influence patient wait times, total visit lengths, or satisfaction.
The conclusions that were drawn were that patient-reported outcomes can be systematically assessed in children and adolescents with acute hand and wrist injuries. The PODCI is reliable, responsive to changes over time, and able to discriminate between populations. The PODCI has potential to be an effective clinical and research tool for assessing and improving patient outcomes.
The HandTutor and its sister devices ( ArmTutor, Leg Tutor and 3d Tutor) have been developed to teach children how to reuse their joints after hand and wrist injuries in addition to stroke, brain and spinal cord injuries, CP, MS, Complex Regional Pain Syndrome and a host of other serious debilitating diseases. The unique and successful devices use a dedicated software that utilizes games to enhance and improve their movement. The games, such as, Car Race, Snowball, Catch The Ball, Sky Defender and others captivate and motivate the child to excel and thereby to improve their range of motion and general use of the hand or wrist. The ”Tutors” also use tele rehabilitation 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.

Tutor system Enhances Therapy for Stroke, Brain Injury Patients

Writing in The Palo Alto Online News September 20, 2011, Sue Dremann reports that the first patient in the western United States to get embryonic stem cells to treat paralysis underwent treatment at Santa Clara Valley Medical Center Saturday (Sept. 17), according to a statement by Stanford University School of Medicine.
Stanford School of Medicine and Santa Clara Valley are working together on the research, which could potentially restore functions to people with stroke, brain injury, Parkinson’s disease and other devastating neurological disorders.
The medical centers have enrolled the fourth participant in the nation’s first trial of cells derived from human embryonic stem cells. The FDA-approved trial is meant to test the safety of the cells in up to 10 people with recent spinal-cord injuries at seven trial sites across the United States.
Stanford neurosurgeon Gary Steinberg, M.D., implanted the cells. Three other patients have previously received the surgically delivered cells: two at the Shepherd Center in Atlanta beginning in October 2010, and one at Northwestern Memorial Hospital and the Rehabilitation Institute of Chicago in May 2011.
The Stanford/Santa Clara Valley patient is the first person to receive the therapy west of the Mississippi, Stanford researchers said.
Stephen McKenna, M.D., chief of the rehabilitation center at Santa Clara Valley, stated,
“It has been an extraordinarily collaborative process at every step, from developing the screening process and identifying possible patients to evaluating these patients for surgery. Although it’s been an intensive commitment of resources, we understand the importance of advancing new therapies for patients,” he said.
The trial is being run by Geron Corp. of Menlo Park, Calif., which developed and manufactures the cells being tested. In May, Geron received a $25 million grant from the California Institute for Regenerative Medicine to continue and extend the trial to include a greater proportion of spinal-cord injuries.
“When the people of California voted in favor of Proposition 71, they did so with the hope of seeing stem-cell-based therapies for chronic disease and injuries. This first California patient to participate in Geron’s landmark spinal cord injury trial is a major step toward fulfilling that hope,” said Jonathan Thomas, chair of the California Institute of Regenerative Medicine governing board.
Researchers at Geron collaborated with Hans Keirstead and his laboratory team at UC-Irvine to develop a way to coax human embryonic stem cells to become a mixture of cells that include oligodendrocyte precursors.
Following the surgery the patient entered an intensive inpatient rehabilitation program. Researchers will now monitor the patient for any adverse effects to confirm that the cells are safe for use in humans.
“In the future, cellular therapies such as those used today will open new hopes for a cure to catastrophic neurological injuries,” McKenna said.
Enhancing the rehabilitation process the HandTutor, ArmTutor, LegTutor and 3DTutor have proven to be successful in restoring full use of the affected joints for brain injury, stroke, Parkinson’s disease and many other neurological disorders.The newly developed Tutor devices 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. The Tutors 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. The Tutor devices are adaptable for children and adults.

Physiotherapy That Includes ArmTutor and HandTutor Augments Dexamphetamine

Dr. Ettlin Thierry etal of the University of Applied Science Northwestern Switzerland, Basel, Switzerland reported in a study that for early inpatient stroke rehabilitation, the effectiveness of amphetamine combined with physiotherapy varies across studies. The investigation was conducted to find out whether the recovery of activities of daily living (ADL, primary outcome) and motor function (secondary outcome) can be improved by dexamphetamine added to physiotherapy.
In a double-blind, placebo-controlled trial, 16 patients, from 918 who were screened, were randomized to the experimental group (EG, dexamphetamine + physiotherapy) or control group (CG, placebo + physiotherapy). Both groups received multidisciplinary inpatient rehabilitation. Dexamphetamine (10 mg oral) or placebo was administered 2 days per week before physiotherapy. ADL and motor function were measured using the Chedoke–McMaster Stroke Assessment (CMSA) twice during baseline, every week during the 5-week treatment period, and at follow-up 1 week, 6 months, and 12 months after intervention.
The results found that the majority of ineligible patients had too little paresis, were on anticoagulants, or had a stroke >60 days prior to entry. Participants (EG, n = 7, age 70.3 ± 10 years, 5 women, 37.9 ± 9 days after stroke; CG, n = 9, age 65.2 ± 17 years, 3 women, 40.3 ± 9 days after stroke) did not differ at baseline except for the leg subscale. Analysis of variance from baseline to 1 week follow-up revealed significant improvements in favor of EG for subscales ADL (P = .023) and arm function (P = .020) at end of treatment. No adverse events were detected.
Dr. Thierry concluded that in this small trial that was based on prior positive trials, significant gains in ADL and arm function suggest that the dose and timing of dexamphetamine can augment physiotherapy. Effect size calculation suggests inclusion of at least 25 patients per group in future studies (ClinicalTrials.gov number:NCT00572767).
When including the HandTutor and ArmTutor in physiotherapy the improvement in joint movement usually improves more rapidly.The HandTutor™ system is an active exercise based hand rehabilitation program that uses the accepted methods of impairment oriented training (IOT) with augmented feedback. The HandTutor™ evaluates and treats finger and hand movement dysfunction through exercises that encourage extension/ flexion of the finger(s) and wrist.
The HandTutor™ system consists of a safe comfortable glove, with position and speed sensors that precisely record finger and wrist motion, and dedicated rehabilitation software. The ergonomic gloves come in five sizes for both right and left hands. The rehabilitation system employs the known concept of biofeedback to give occupational and physical therapists access to an affordable user friendly hand rehabilitation package. The HandTutor™ can also be used in combination with the 3DTutor™ for arm rehabilitation. The HandTutor™ is CE medical and FDA certified
The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The ArmTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The ArmTutor™ and its sister devices (LegTutor and 3DTutor) allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multijoints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The ArmTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

UCLA’s Sean Sheller Can Regain Full Use of Arm With ArmTutor Therapy

UCLA offensive lineman Sean Sheller will have surgery to repair two broken bones in his left arm on Tuesday.
Sheller, a sixth-year senior, was injured against Texas when his arm was caught between two helmets on a play near the goal line. The surgery will require placing plates and screws on the bones to help it heal.
The injury ends his season — and his college career.
Sheller overcame two knee surgeries to become a key member of the offensive line. He injured his right knee in 2006 and his left knee in 2008. He recovered and started 13 of the last 14 games.
Sheller played both tackle positions, but was moved to guard for the Texas game. Although he won’t return to his favorite sport Sheller can speed the recovery of his arm through the use of the ArmTutor.
The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The ArmTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice. (Some of the games entail keeping a ball in its proper alignment which should keep Sean happy to compete with a ball).
The ArmTutor™ allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multijoints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The ArmTutor™ system and its sister devices (HandTutor, LegTutor and 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

LegTutor- a Helpful Aid in Speeding Recovery of Injured Footballer Chris Norton

They say coin tosses are 50-50 odds — half the time it comes up heads, the other half tails. But the Luther College football team could have bet the whole campus the coin was coming up in their favor Sept. 10.
After all, their man Chris Norton was on the field for the pregame toss. And the Altoona 19-year-old has beaten far worse odds than 50-50.
Eleven months ago, Norton, a Bondurant-Farrar High School alumnus, broke his neck during a kickoff return against Central College. The injury compressed his spinal cord. The doctors initially gave Norton a 3 percent chance of ever having movement below his neck.
But Norton moved into that 3 percent his first full day of recovery. After emergency surgery at the Mayo Clinic in Rochester, Minn., Norton moved his arms, the first twitches in a long recovery.
He joined his teammates at midfield for the coin toss before William Penn’s 24-13 win Sept. 10.
He uses a wheelchair, but he’s learning to walk again. He returned to school this fall taking three courses. He does intense therapy with the Luther sports medicine staff, the Winneshiek Medical Center and two days a week at Mayo. He’s got a long way to go, but he’s already further than anybody every thought he’d be.
With the newly developed LegTutor Chris Norton can speed his recovery and return to the football field.
The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the lower extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The LegTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The LegTutor™ allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The LegTutor™ system and its sister devices (HandTutor, ArmTutor and 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

LegTutor Raises Patient Satisfaction After Knee Surgery

In papers presented at a symposium of the ANNUAL MEETINGS OF THE KNEE SOCIETY and published in CLINICAL ORTHOPAEDICS AND RELATED , RESEARCH®Volume
468, Number 1, Dr. Robert B. Bourne etal reported that despite substantial advances in primary TKA, numerous studies using historic TKA implants suggest only 82% to 89% of primary TKA patients are satisfied. We reexamined this issue to determine if contemporary TKA implants might be associated with improved patient satisfaction. We performed a cross-sectional study of patient satisfaction after 1703 primary TKAs performed in the province of Ontario. Our data confirmed that approximately one in five (19%) primary TKA patients were not satisfied with the outcome. Satisfaction with pain relief varied from 72–86% and with function from 70–84% for specific activities of daily living. The strongest predictors of patient dissatisfaction after primary TKA were expectations not met (10.7× greater risk), a low 1-year WOMAC (2.5× greater risk), preoperative pain at rest (2.4× greater risk) and a postoperative complication requiring hospital readmission (1.9× greater risk).
The LegTutor has been known to improve leg and foot movement in patient therapy following TKA and other lower extremity surgeries and injuries. The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the lower extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The LegTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The LegTutor™ allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The LegTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

The LegTutor–an Excellent Therapy for MMT Issues

Drs. Y. Hara , K. Matsudaira, N. Hara and H.Oka of the Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo writing in J Orthop Sci. 2011 Sep 16. have found that although extensor hallucis longus (EHL) strength has been identified as a primary predictor of L5 nerve root radiculopathy and deep peroneal nerve palsy, assessment of EHL strength is commonly overlooked. This is mainly due to the lack of an objective and accurate method for evaluation, since manual muscle testing (MMT) has not been well utilized. A study of the reliability of evaluating MMT in various toe positions was performed.
To determine the reliability and validity of MMT for great toe extension, 40 normal volunteers (80 toes) with good muscle strength were recruited. Each subject was examined with MMT at the MTP joint (MTPp) and IP joint with various positions of the MTP joint (maximal extension: IPp-e, neutral position: IPp-n, maximal flexion: IPp-f) by two examiners. Inter-observer reproducibility was calculated for each MMT by κ values. Correlations between the great toe length and great toe extensor strength in each position, and between the angle in maximal extension of the MTP and great toe extensor strength in each position were examined using Spearman’s correlation test.
The results they found were that the great toe extensor strength was highly maintained in MTP measurement. Correct detections in each position (MTPp, IPp-e, IPp-n, IPp-f) were 96.3 and 96.3; 45.0 and 32.5%; 53.8 and 33.8%; and 50.0 and 61.5% for the first and second observer, respectively. The inter-observer variability for great toe extensor strength was highly maintained in MTP measurement (κ values = 1.00). The κ value of each position was 0.69, 0.35, and 0.28 for IPp-e, IPp-n, and IPp-f, respectively. There were no correlations between great toe length or angle in extension of the MTP and great toe extensor strength in each position.
This study demonstrated that MTPp was much superior to the IP joint in the MMT procedure for great toe extension.
The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the lower extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The LegTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The LegTutor™ is an excellent aid for MMT and also allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The LegTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.
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Rehabilitation, Physical Therapists, Physiotherapy, Tutor System–a winning combination

In an article in the The Times of India, September 17, 2011 Monami K. Thakur writes in “Health Me Up” Spinal Cord Injuries (SCIs) are quite debilitating and can happen to any one at any time. Such injuries may vary from minimum impact to total loss of function.
Besides trauma, SCIs can also occur from certain diseases and infections like some cancers, spinal cord vascular diseases and vertebral injuries. Although no definite procedures can completely reverse the damage and regenerate the lost nerve functions, treatment and rehabilitation may help one resume an active life. Used in conjunction with the HandTutor, LegTutor, ArmTutor and 3DTutor the best treatment is available for joint rehabilitation.
Rehabilitation phases: Rehabilitation usually starts during the early stage of recovery once the destabilizing factor is medically removed. In case of trauma, the process starts after the immediate medical care is complete. The process is broadly segregated into two phases – early rehabilitation and long term care. The early rehabilitation focuses on increasing functional independence and restoring lost neuro-muscular functions. Long term care involves recreational and vocational training, which determines likelihood for employment depending on dexterity and physical and cognitive functions. The Tutor system is designed to improve dexterity and physical functions.
Rehabilitation team: A spinal injury rehabilitation team comprises specialists from different sectors of medical and paramedical sectors. Usually led by a doctor specialized in physical medicine and rehabilitation, the team also includes rehabilitation nurses, physiotherapists, rehabilitation psychologists, nutritionists, recreational therapists and vocational specialists among others. Each team member has specific tasks oriented towards helping the patient to lead as active a life as possible. With the HandTutor, ArmTutor, LegTutor and 3DTutor the physical therapist has objective quantitative evaluations that provide him information to customize the most suitable rehabilitation program to the patient’s ability.
Physiotherapy: Physical therapists play a very important role in assisting the immobilized patients with effective stretching techniques, teaching wheelchair skills, breathing exercises and chest clearance (for instance better coughing techniques). Such procedures help the patient overcome complications of immobilization associated with SCI like contractures, bed sores and fluid accumulation in the lungs. When joint movement is affected the Tutors assist in intensive exercise programs via dedicated software which allows the therapist to fully customize the program to the patient’s movement ability.
Treatment as per level of involvement: Usually, the treatment procedures vary depending on the spinal cord involvement and the outcome of injury. Different levels of SCI will exhibit different symptoms in a patient. Besides this, rehabilitation also depends on whether the injury is complete or incomplete. In incomplete injuries, the spinal cord’s ability to convey messages to and from the brain is not completely lost, as opposed to complete injuries. Also, the level of injury determines whether a patient will be quadriplegic (all four limbs affected) or paraplegic (only legs and trunk affected). When the injury is incomplete the Tutors are the most effective.
The LegTutor, for example, has shown great success in rehabilitating knees post surgery. This innovative device is a brace attached to the affected leg and is connected by sensors to a computer with a dedicated intensive exercise program.
The HandTutor™ system is an active exercise based hand rehabilitation program that uses the accepted methods of impairment oriented training (IOT) with augmented feedback. The HandTutor™ evaluates and treats finger and hand movement dysfunction through exercises that encourage extension/ flexion of the finger(s) and wrist.
The HandTutor™ system consists of a safe comfortable glove, with position and speed sensors that precisely record finger and wrist motion, and dedicated rehabilitation software. The ergonomic gloves come in five sizes for both right and left hands. The rehabilitation system employs the known concept of biofeedback to give occupational and physical therapists access to an affordable user friendly hand rehabilitation package. The HandTutor™ can also be used in combination with the 3DTutor™ for arm rehabilitation.
The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up.
The Tutor system is widely used by leading U.S. and foreign hospitals and clinics. It can also be used at home through telerehabilitation.

Post TraumaTherapy Enhanced by Tutor System

On September 15, 2011, Stacy Stark , an assistant professor in the Department of Physical Medicine and Rehabilitation and the medical director of the Outpatient Physical Medicine and Rehabilitation Clinic and director of Education for the Department of Physical Medicine and Rehabilitation at Pennsylvania State University wrote for Medical Express.com,
“Imagine that you are driving home from work when you are involved in a head on collision with an SUV. Life Lion flies you to the hospital. When you awake in the Emergency Department, you notice that you cannot feel your legs. Your doctor tells you that you may not able to walk. You also eventually realize that you cannot urinate or defecate voluntarily.
This is an all too familiar scenario for many people within the United States. Motor vehicle crashes are the No. 1 cause of spinal cord injury (SCI). Approximately, 10,000 people in the U.S. will suffer a new SCI this year, and approximately 250,000 people in the U.S. are living with SCI.
The most common level of tetraplegia (paralysis with all four extremities involved) is cervical level 5. This means you cannot move your hands, wrists, and legs and your sensation stops slightly below the nipple line, with no feeling below that. The most common level of paraplegia (paralysis with legs involved) is thoracic level 12. This means you cannot move your legs and your feeling stops at your waist, with no sensation below that.
When SCI is complete, you have no movement or feeling below the level of injury. However, many people do regain some movement and sensation after injury.
Approximately 80 percent of patients with complete injury have a chance of remaining complete at one year. Those with an initial certain incomplete injury with certain characteristics — sensation and or movement below the level of injury — have a variable recovery prognosis, sometimes with as high as a 90 percent chance of walking again following rehabilitation.
SCI has a long recovery. After the acute hospital stay, many patients enter acute inpatient rehabilitation during which patients still require medical care, but receive three hours of therapy every day, five days a week. This rehabilitation lasts for approximately four weeks. During this phase, the patient learns how to care for themselves, and the patient and family are educated about daily care and how to perform it, if applicable.
When at least partial sensation is present following a traumatic injury the Tutor system doesn’t take a back seat to any current physical therapy assistance available.
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.

LegTutor an Integral Part of Physical Therapy

SHANNEN HAYES writing in the Island Reporter on September 17, 2011 explains that Sanibel Island is well-known for its active senior population. What is the secret to staying active well after retirement or even knee replacement surgery? For more than 12 years, Physical Therapy of Sanibel has been providing quality rehabilitation services to islanders and visitors. For the past 8 years, physical therapist David Lackenby has been helping his patients with a wide range of conditions, including arthritis, neck and back pain, headaches and balance impairments, and has extensive experience with post-joint replacement rehabilitation.
Physical therapists or PTs are described as health care professionals who diagnose and treat individuals of all ages, from newborns to the elderly, who have medical problems or other health-related conditions that limit their ability to move and perform functional activities in their daily lives.
PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.
Physical therapists provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a physical therapist practices. They focus on manipulation to help mobilize joints, along with manual therapy.
The LegTutor and its sister devices, (HandTutor, ArmTutor and 3DTutor), have become an integral part of physical therapy for victims of brain and spinal cord injury, stroke, post arm and knee surgery therapy as well as Parkinson’s, MS, CP, Apraxia, Development Coordination Disorders, balance impairments, arthritis, sports injuries and more.
The LegTutor, specifically, provides a safe and comfortable leg brace with position and speed sensors that precisely record three dimensional hip and knee extension and flexion. Rehabilitation games allow the patient to exercise Range of Motion (ROM), speed and accuracy of movement. The LegTutor facilitates evaluation and treatment of the lower extremity including isolated and combined hip and knee movements.
The LegTutor aims to optimize motor, sensory and cognitive performance to allow the patient to better perform everyday functional tasks and improve quality of life. The Tutors are being successfully used in leading U.S. and foreign hospitals and clinics and are suitable for home use through telerehabilitation.

ArmTutor An Integral Part of Physical Therapy for Sports Injury Victims

In a special report by Peter Yoon to ESPNLosAngeles.com on September 17, 2011 he states that UCLA Bruins offensive lineman Sean Sheller has a broken right arm that will require surgery and will be out indefinitely, the school announced Saturday after a 49-20 loss to Texas on Saturday.
Sheller, a sixth-year senior and a starting guard, was injured on a running play near the goal line late in the third quarter. UCLA was trailing 35-13 at the time, but scored two plays later to make it 35-20.
Sheller has already missed two full seasons with injuries. He had a medial collateral ligament tear in his right knee in 2006 and had anterior and medial collateral ligament surgery in 2008 after an off-road vehicle accident.
Also, defensive back Andrew Abbott suffered a concussion on a hit to the head in the second quarter and will spend the night in a hospital for observation.
The ArmTutor for Sean Sheller and the 3DTutor for Andrew Abbott may be just what the doctor ordered to help them recover faster. The ArmTutor and the 3DTutor, together with their sister devices the HandTutor and LegTutor, are newly developed medical devices . They have become a key system in neuromuscular rehabilitation and physical therapy for post surgery sports related injuries as well as a host of other disabilities. 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.

Tutor System a Helpful Aid to War Veteran’s Disabilities

David Wood writing in the HuffPost, part of the Huffington Post newspapers Septemeber 15, 2011 submits the following item:They all have different stories. Blinded by an explosion. Paralyzed legs from a helicopter crash. Traumatic brain injury from repeated IED blasts, resulting in anger and suicide attempts. Scarred and malformed limbs from a roadside bomb blast. Missing arms, missing legs.
But these wounded warriors, who volunteered and served in the post-9/11 wars in Afghanistan and Iraq, have one thing in common: They’re not sitting at home in depression and self-pity. Instead, they are joyfully — and sweatily — riding an eight-day, 542-mile bicycle trip from Ground Zero in New York to the Pentagon, both to celebrate their camaraderie and to raise money to help other wounded warriors recover through cycling.
For them, the years since 9/11 have been a time of renewal, of community and of inspiring others.
“My guys didn’t save me to sit at home,” explained Gary Linfoot, a former special operations pilot with 21 combat missions in Iraq and Afghanistan. Pulled from the wreckage of his AH-6 helicopter after it crashed in Iraq three years ago, he is paralyzed from the waist down. Like for others, cycling has given him a way to stay fit and work himself back into the world of high-intensity achievers, like those in his old special ops unit.
There are 350 of them, almost all wounded warriors, who laid wreaths of remembrance at Ground Zero on Sept. 10, then launched out on their bikes on 9/11, pushing 50 miles toward the Pentagon that day. Riding between 50 and 90 miles a day, they are scheduled to arrive at the Pentagon for a memorial and celebration on Sunday, Sept. 18.
Brain injuries from war traumas are amongst a host of disabilities that are easily treated by the Tutor system.
The Tutor system allows the patient to do intensive exercise practice that is customized to their movement ability, either with Passive Range Of Motion or Active Range Of Motion. The latter is the displacement of the joint in degrees when the person themselves moves the joint. We work with the active range of motion and set up a series of computerized games so that the patient can complete it within their active range of motion. The therapist can also assist the patient to move the limb.
The games are customized to a range of motion, speed and accuracy of the patient’s available active or assisted active movement ability. We set the game slightly above the patients movement ability so that they are encouraged and motivated to work harder and practice the controlled movement within the game. The aim is to improve the patient’s movement ability so they are better able to function.
The new FDA and CE certified HandTutor, ArmTutor, LegTutor and 3D Tutor have been developed to improve joint movement in brain and spinal cord injury victims. 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. The devices also treat those suffering from MS, Parkinson’s, spinal cord injuries Apraxia among other disabilities.
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Post Ligament-Transplant-Surgery-Therapy Can Be Improved with the ArmTutor

Carolyn Y. Johnson writing in the Boston Globe September 15, 2011 reports about David Leone who left behind his familiar wheelchair, shifting himself onto a chair where a robotic external skeleton fitted to his 5-foot-11-inch frame sat waiting. Half a dozen people scurried around him, cinching Velcro straps tight around his legs and torso. He grabbed the handles of a walker, leaned forward, and hoisted himself to his feet.
Seven years after he last walked, Leone – paralyzed from the waist down – lifted his right foot and took a step, with the robotic technology moving his limbs.The 37-year-old from Millis kept on going, racking up 284 steps in a 42-minute session this week at Spaulding Rehabilitation Hospital in Boston.
Leone, paralyzed since he fell backward off a ladder in 2004, is among the first people with spinal cord injuries to try out eLEGS. The robotic technology, developed by a California company called Berkeley Bionics, is undergoing investigational studies at Spaulding and nine other rehabilitation centers.
The device is completely external, initially with steps triggered by pushing a button on a remote control. That spurs the device’s computer to coordinate the complicated choreography of a step, utilizing motors and sensors at the knees and hips. The machine does all the work, but it’s up to the patient to learn again how to walk, how to lean forward into the opposite foot, how to move with confidence when there is no feedback from the lower half of your body.
Researchers looking for ways to help people with spinal cord injuries are moving forward on multiple fronts, ranging from biological approaches aimed at regenerating injured tissue, to protective approaches that minimize the damage in the immediate aftermath of an injury, to engineering approaches that use robotics or implanted technology to restore mobility. The research, however, is still at an early stage in many of these areas.
If biological therapies are successful in restoring injured tissue, for example, patients would need rehabilitation devices that help retrain them how to use their muscles and bodies. However when there is at least partial movement ability the LegTutor comes in being very helpful.
The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the lower extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The LegTutor™, together with its sister devices (the HandTutor, ArmTutor and 3DTutor), rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The LegTutor™ allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The LegTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

Post Ligament-Transplant-Surgery-Therapy Can Be Improved with the ArmTutor

Carroll Rogers reports that under the guise of working back from elbow surgery with an eye toward next season, Kris Medlen has actually been building up his arm strength to make a comeback attempt for the playoffs.
Medlen is scheduled to throw live batting practice Saturday for the first time in his 13-month recovery. If he can get back into game action before the regular season ends Sept. 28, the Braves will consider adding Medlen to their bullpen for the postseason.
“We are progressing him with no expectations other than if he pitches at the end of the season, we will then consider how he fits,” Braves general manager Frank Wren said.
Medlen suffered some scar tissue breakup in June, a common setback in recovery from ligament transplant surgery. But soreness lingered when he got back on the bullpen mound, so he was shut down for five weeks starting in mid-July. Medlen got a platelet-rich plasma injection in his elbow. He said that and the rest helped.
Medlen threw his fifth bullpen in the past 11 days on Wednesday without discomfort.
“There’s no pain, and that’s the most important part,” Medlen said. “It’s just a matter of me getting my stuff back and getting the feel of everything. That would be the most important part for me to come back and help at all. I’m going to have to speed it up a little bit.”
Medlen, who underwent “Tommy John” surgery on Aug. 18, 2010, was originally targeting a return to the mound in late August. After two setbacks and some indications he wouldn’t return this season, he is just happy for the chance.
“I’m super excited,” Medlen said. “Frank sat right next to me, face-to-face and told me the plan, and I was just like ‘(Heck) yeah. Let’s do this.’ It’s been long enough.”
The Braves can use more depth in their bullpen and help against left-handers. Left-handed specialist George Sherrill is still nursing a sore left elbow and not scheduled to throw off a mound until Friday. Left-handers are hitting.310 (22-for-71) against Scott Linebrink for the season and 4-for-7 so far against Peter Moylan.
For his career, Medlen has held left-handers to a .240 average, and right-handers to .282. In 2009, when Medlen pitched primarily in a relief role, left-handers hit only .183 off him.
“After the shot and the five weeks off that I had, there’s no doubt my ligament is strong and I’m not holding back at all,” Medlen said. “I’m not saying I’m going to come in throwing 92, but let it go, and I’m not afraid of it popping it again or anything. It’s completely different than it was a month and a half ago.”
The ArmTutor™ system has been developed to allow for functional rehabilitation after arm and elbow surgery and for the whole upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The ArmTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease. The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The ArmTutor™ allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multijoints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The ArmTutor™ system is used by many leading rehabilitation centers and hospitals across the U.S. and in foreign countries.

Tutor System Integral part of Burn Victim Therapy

A review conducted by LM Disseldorp etal on Physical fitness in people after burn injury. The objective was to gain insight into the physical fitness of people after burn injury compared with healthy subjects, and to present an overview of the effectiveness of exercise training programs in improving physical fitness in people after burn injury.
The review includes studies that provide quantitative data from objective measures of physical fitness of both the intervention group and the control group.
Characteristics of each study such as study design, institution, and intervention are reported, as well as mean ages and burn sizes of the subjects. Results are divided into 5 components of physical fitness—muscular strength, muscular endurance, body composition, cardiorespiratory endurance, and flexibility—and reported for each component separately.
Eleven studies met the inclusion criteria, and their methodological quality was assessed using the PEDro score and a modified Sackett scale. Six studies were used for the comparison of physical fitness in burned and nonburned subjects, and 9 studies for evaluating the effectiveness of exercise training programs.
The conclusions drawn were that physical fitness is affected in people with extensive burns, and exercise training programs can bring on relevant improvements in all components. However, because of the great similarities in the subjects and protocols used in the included studies, the current knowledge is incomplete. Future research should include people of all ages with a broad range of burn sizes, for both short-term and long-term outcomes.
The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy for burn victims and those suffering from many other disabilities. 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.

HandTutor Beneficial for Spasticity Issues

Dr.Yong Jae Jung etal of the Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea writing in the Journal, NeuroRehabilitation Volume 29, Number 1 / 2011 conducted a study and stated,
“We attempted to evaluate the effect of a stretching device for treatment of hand spasticity in chronic stroke patients. We recruited 21 chronic hemiplegic stroke patients with severe finger flexor spasticity and randomly assigned them to the intervention group (10 patients) and control group (11 patients). The stretching device consisted of a resting hand splint, finger stretcher, and frame. The stretching state was maintained for 30 seconds and relaxed for the next 30 seconds. This stretching and relaxation were repeated for 20 minutes (one session). The stretching program was practiced 2 sessions/day and 6 days/week for 3 weeks for the patients of the intervention group. The effect of this stretching device was assessed using the modified Ashworth scale (MAS) score of finger flexor muscles. Patients in both groups were assessed six times within an interval of one week and patients in the intervention group were assessed two times before starting the stretching program. The two-way repeated measures analysis of variance (ANOVA) test for evaluation of the effect of intervention across all time-points between the two groups showed a significant interaction between time and effect of intervention (P < 0.001). Within the intervention group, the average of mean MAS score at Pre-1 and Pre-2 were 2.83 and 2.93, respectively (the difference between Pre-1 and Pre-2 was not significant (P> 0.05)), and this improved significantly to 1.97 at Inter-1, 1.55 at Inter-2, 1.20 at Inter-3, and 1.97 at Post-1 (P < 0.001) using the one-way repeated measures ANOVA test for evaluation of the effect of intervention across all time-points. We found that our stretching device was effective in relieving hand spasticity in chronic stroke patients”.
Stroke patients with hand spasticity issues can benefit from the HandTutor.
The HandTutor™ system is an active exercise based hand rehabilitation program that uses the accepted methods of impairment oriented training (IOT) with augmented feedback. The HandTutor™ evaluates and treats finger and hand movement dysfunction through exercises that encourage extension/ flexion of the finger(s) and wrist.
The HandTutor™ system consists of a safe comfortable glove, with position and speed sensors that precisely record finger and wrist motion, and dedicated rehabilitation software. The ergonomic gloves come in five sizes for both right and left hands. The rehabilitation system employs the known concept of biofeedback to give occupational and physical therapists access to an affordable user friendly hand rehabilitation package. The HandTutor™ can also be used in combination with the 3DTutor™ for arm rehabilitation. The HandTutor™ is CE medical and FDA certified.

Post Stroke Patient Benefits from HandTutor

Dr. A.T. Patel, MD, Kansas City Bone and Joint Clinic, PA, and The Rehabilitation Institute of Kansas City, Kansas City, Missouri. writing in the journal PHYSICAL THERAPY, August 2011 about poststoke spasticity. Poststroke spasticity often negatively affects functional activities and daily living and frequently is accompanied by pain, abnormal limb postures, and contractures. The purpose of this case report is to describe the long-term benefit of botulinum toxin A in a patient with poststroke spasticity.
A 35-year-old woman with poststroke upper-limb spasticity who had lost function in her left hand was treated with onabotulinumtoxinA and physical therapy. Over 25 months, the patient underwent a physical therapy and occupational therapy program and received onabotulinumtoxinA injections into muscles of the left hand and arm, significantly reducing tone and facilitating recovery of function. Practical assessments, the Ashworth Scale, and electrophysiology were used to measure changes over time. No functional scales or dexterity scales were used to measure changes.
The outcomes were that OnabotulinumtoxinA injections were discontinued when treatment goals were attained, and no further improvements were achieved. After more than 2½ years without further onabotulinumtoxinA treatments, the patient maintained range of motion and some functional use and dexterity in her left hand.
This case report illustrates the efficacy and long-term benefit of onabotulinumtoxinA, combined with a physical therapy program, in the successful treatment of poststroke spasticity.
The preferred method of physical therapy for poststroke victims who lack normal movement in their hand or arm is the HandTutor.
The HandTutor™ system is an active exercise based hand rehabilitation program that uses the accepted methods of impairment oriented training (IOT) with augmented feedback. The HandTutor™ evaluates and treats finger and hand movement dysfunction through exercises that encourage extension/ flexion of the finger(s) and wrist.
The HandTutor™ system consists of a safe comfortable glove, with position and speed sensors that precisely record finger and wrist motion, and dedicated rehabilitation software. The ergonomic gloves come in five sizes for both right and left hands. The rehabilitation system employs the known concept of biofeedback to give occupational and physical therapists access to an affordable user friendly hand rehabilitation package. The HandTutor™ can also be used in combination with the 3DTutor™ for arm rehabilitation. The HandTutor™ is CE medical and FDA certified. Now being used in leading U.S. and foreign hospitals and clinics the Tutor system (ArmTutor, LegTutor, 3DTutor) can be used by recovering patients at home through the use of telerehabilitation.