Dr.Takashi Morishita et al writing in the ''Neurologist'' September 2011 - Volume 17 - Issue 5 - p 263–268
doi: 10.1097/NRL.0b013e31822d1069 states that candidacy for deep brain stimulation (DBS) in Parkinson disease (PD) is typically assessed by the preoperative motor response to levodopa along with an interdisciplinary evaluation. However, recent cases treated at our institution have achieved good outcomes with DBS despite a sub-30% improvement in motor scores. The aim of this study was to examine the outcomes of DBS in a subset of patients who failed to reach the 30% motor improvement threshold.
In this study a review of all DBS patients treated at the University of Florida Movement Disorders Center between 2002 and 2009 was performed utilizing a DBS database. All patients with sub-30% improvement in Unified Parkinson Disease Rating Scale Part III after dopaminergic medication administration were included.
The results of the study were that nine patients were identified; DBS was performed for severe dyskinesia (n=5), “on/off motor” fluctuations (n=1) and medication-refractory tremor (n=3). The target symptoms were improved in all patients. Postoperatively, scores on the Unified Parkinson Disease Rating Scale Part II and III and subscores on Parkinson disease questionnaire-39 improved (P<0.05).
The conclusions drawn were that although motor response to levodopa remains the primary selection criteria for DBS candidacy in Parkinson disease, patients who do not meet the 30% threshold and have disabling symptoms may still benefit from DBS. Select patients with severe dyskinesia, “on/off” motor fluctuations, and/or medication-refractory tremor may experience significant benefits from DBS and should be considered on a case by case basis through an interdisciplinary team evaluation.
The HandTutor, ArmTutor, LegTutor and 3DTutor are devices that are FDA approved 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 Parkinsons and traumatic injuries as well as being effective for post stroke victims or those suffering from Cerebral Palsy, spinal cord and brain injuries, Apraxia, MS, 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.
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