Tutor System Plays an Important Role in Home Based Stroke Rehabilitation

On February 11, 2011 Margo Warren and Marian Emr of the National Institute of Neurological Disorders and Stroke report that in the largest stroke rehabilitation study ever conducted in the United States, stroke patients who had physical therapy at home improved their ability to walk just as well as those who were treated in a training program that requires the use of a body-weight supported treadmill device followed by walking practice.
The study, funded by the National Institutes of Health, also found that patients continued to improve up to one year after stroke, defying conventional wisdom that recovery occurs early and tops out at six months. In fact, even patients who started rehabilitation as late as six months after stroke were able to improve their walking.
Walter Koroshetz, M.D., NINDS deputy director said ”The results of this study show that the more expensive, high tech therapy was not superior to intensive home strength and balance training, but both were better than lower intensity physical therapy.”
“We were pleased to see that stroke patients who had a home physical therapy exercise program improved just as well as those who did the locomotor training,” said Pamela W. Duncan, Ph.D., principal investigator of LEAPS, and professor at Duke University School of Medicine in Durham, N.C. ”The home physical therapy program is more convenient and pragmatic. Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life.”
The home exercise programs require less expensive equipment, less training for the therapists and fewer clinical staff members. The LEAPS authors suggest that this intervention may help keep stroke survivors active in their own homes and community environments.
The newly developed Tutor System consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor has been designed to be used at home with telerehabilitation in addition to the hospital or outpatient clinic. It improves fine motor, sensory and cognitive impairments through augmented feedback for victims of stroke, Parkinson’s disease, MS, CP, Spinal cord, brain,Radial/Ulnar nerve and Brachial Plexus injuries amongst other disabilities.
The Tutor system has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. The system consists of ergonomic wearable devices and dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation and objective follow up.
The new medical devices are available for children as well as adults and are FDA and CE certified. See www.HandTutor.com for more information.

Upper Extremity Elbow Flexion Shows Improvement with ArmTutor

On November 28, 2011 M.J. Dorsi and A.J. Belzberg of the Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, MD. write that Transverse myelitis (TM) may result in permanent neurologic dysfunction. Nerve transfers have been developed to restore function after peripheral nerve injury. Here, we present a case report of a child with permanent right upper extremity weakness due to TM that underwent nerve transfers. The following procedures were performed: double fascicle transfer from median nerve and ulnar nerve to the brachialis and biceps branches of the musculocutaneous nerve, spinal accessory to suprascapular nerve, and medial cord to axillary nerve end-to-side neurorraphy. At 22 months, the patient demonstrated excellent recovery of elbow flexion with minimal improvement in shoulder abduction. We propose that the treatment of permanent deficits from TM represents a novel indication for nerve transfers in a subset of patients.
The ArmTutor has shown to be effective in resolving movement ability especially with upper extremity and shoulder abduction difficulties during rehabilitation therapy.
The ArmTutor™ 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 together with its sister devices (HandTutor, LegTutor, 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See www.HandTutor.com for more information.

Cognitive Impairments Improved With HandTutor Following Stroke

S.E. McEwen etal of the Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada.completed a study whose objective was to examine the literature regarding the use of cognitive strategies to acquire motor skills in people who have had a stroke, to determine which strategies are in use and to compile evidence of their effectiveness.
The results found were that out of twenty-six articles reviewed seven investigated general cognitive strategies and 19 investigated task-specific strategies. The most commonly studied task-specific strategy was motor imagery. Findings suggest that general strategy training improves performance in both trained and untrained activities compared to traditional therapy; and that a specific motor imagery protocol can improve mobility and recovery in the affected upper extremity in people living with the chronic effects of stroke.
The conclusion reached was that this foundational evidence supports the further development of novel cognitive strategy-based interventions with the intention of improving long-term stroke outcomes.
THe HandTutor improves fine motor, sensory and cognitive impairments through intensive active exercises with augmented feedback.
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™ and its sister devices (the ArmTutor and LegTutor) can also be used in combination with the 3DTutor™ for arm rehabilitation. The HandTutor™ is CE and FDA certified. See www.HandTutor.com for more information.

Tutor System Integral Part of Children’s Rehabilitation

EVA-MARIE AYALA writing for the Texas based Star Telegram.com tells us that before the crash, Michael Batts was a quick learner and ranked 10th in his class at Paschal High School.
Now, studying requires hours of work with flashcards, notes and continual reviews.
Before the crash, Batts played alto saxophone in the marching band.
Now, after a full day of school, he often needs to sleep for two hours because of mental fatigue.
Before the crash, Batts planned to go to college out of state, perhaps in South Carolina or California.
Now, he accepts that that isn’t realistic anymore because he needs to be closer to doctors and his family.
Michael Batts’ life can be categorized in two chapters: There’s “before” the Nov. 7, 2010, crash, which left him with a broken pelvis, broken ribs and a severe head injury.
And there’s “now.”
Batts, a senior at Paschal, has had to relearn to walk, hold a pencil and talk. He still deals with memory gaps.
But watching a recent TV interview with Rep. Gabrielle Giffords of Arizona, the 17-year-old realized how far he has come.
The special on Giffords, who continues her recovery after being shot in the head, featured home video showing her relearning how to smile — and crying when she couldn’t express herself.
“It put everything in perspective for me from this past year,” Batts said. “I had thought: ‘Yeah, I had a brain injury, but that’s what doctors and therapists do. They help you fix it, and you get better.’ But watching that, I realized how hard it is, and a lot of people don’t get better.”
On Nov. 7, 2010, Batts was supposed to sing with the school choir for a daylong celebration of Paschal’s 125th anniversary that drew alumni from across the decades. But on his way to the festivities, Fort Worth police said, he failed to stop at a stop sign at West Vickery Boulevard and Old Benbrook Road and was hit by a pickup.
He was unconscious for days.
Even after he woke up, he couldn’t remember visitors or therapy from the previous day.
“He didn’t say his first spoken words until Dec. 31,” said his mother, Paula Batts. “I had stepped out of the room, but his doctor told me Michael whispered, ‘Hi, Mom. I love you.’ We didn’t even know if he would ever wake up again let alone be able to walk or talk again. And to come as far as he has? We are so grateful.”
Nationally, about 1.7 million children and adults suffer traumatic brain injury each year. About 3.1 million children and adults in the United States live with a lifelong disability from a traumatic brain injury, according to the Brain Injury Association of America.
While the number of people surviving traumatic brain injuries continues to increase, each case is unique, said Dr. Brent Mizzal, a Galveston-based neurologist who is the association’s national medical director.
“It’s so much more complex than, say, a broken bone,” Mizzal said. “Everyone knows what happens when you break a bone. You put it in a cast and it gets better. It’s hard to tell what will happen with a brain injury.”
Batts’ therapy includes working on motor skills, speech, memory and social skills, which involves, among other things, group therapy with other teens recovering from similar injuries.
The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has been shown to be of immense help in the rehabilitation process for TBI patients whether they are children or adults.
The Tutor system has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. The system consists of ergonomic wearable devices and dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.
The new medical devices are available through the use of telerehabilitation and are FDA and CE certified. See www.HandTutor.com for more information.

Frisbee Player’s Arm Can Speed His Recovery With ArmTutor

ROWENA JOY A. SANCHEZ writing for MB.COM.PH on November 28, 2011 tells us the following story.
Prior to breaking his arm, Derek sustained knee injuries in a Frisbee game last year.
Hunk-actor Derek Ramsay had what he deemed his “biggest nightmare” when he injured himself in a Frisbee tournament held from Nov. 25 to 27 in Alabang.
An operation was scheduled on Nov. 28 at 9 a.m. for his forearm, which, according to Derek’s tweet on Monday, got “broken in three places.” The surgery, he added, is needed to “have metal plates put in.”
Apparently devastated over the incident, Derek bewailed also on Twitter, “Everything happens for a reason. I think this a sign for me to say goodbye to the sport I love so much.”
Derek was very excited over the tournament, as seen in his earlier tweets. Presumably before he got the injury, Derek posted on Nov. 27, “Morning guys!!! Today is the big day!!!!! Hope we win. Pls wish our team luck”
He also updated his followers on Nov. 25 with a series of tweets that went, “We just won our first game,” “We just beat the number one team,” and “Tom and Sunday is the mixed tournament! Hope we win.”
On the same day, however, Derek lamented that his body “is in so much pain. I think it’s time for me to pack up playing disc.”
The actor’s longtime girlfriend Angelica Panganiban urged everyone to pray for him via Twitter also on Sunday.
“Please pray for dereks fast recovery. He got into an accident from frisbee. Broken arms. Needs operation tmrw… Thank you guys,” she posted.
This is not the first time that Derek got injured. Last year, Derek suffered injuries in the anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) of his right knee, while his left suffered a fracture. He eventually had undergone operation and recovered a month after.
Even a frisbee player can expect to get help from the newly developed ArmTutor during his 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 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 together with its sister devices (HandTutor, LegTutor, 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See www.HandTutor.com for more information.
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Improved Limb Motor Training Accelerated by Use of Tutors

Drs.Cheol E. Han, Michael A. Arbib and Nicolas Schweighofer all associated with the University of Southern California in Los Angeles conceived and designed the following experiments: CEH MAA NS. Performed the experiments: CEH. Analyzed the data: CEH NS. Contributed reagents/materials/analysis tools: CEH. Wrote the paper: CEH NS.
Motor training with the upper limb affected by stroke partially reverses the loss of cortical representation after lesion and has been proposed to increase spontaneous arm use. Moreover, repeated attempts to use the affected hand in daily activities create a form of practice that can potentially lead to further improvement in motor performance. We thus hypothesized that if motor retraining after stroke increases spontaneous arm use sufficiently, then the patient will enter a virtuous circle in which spontaneous arm use and motor performance reinforce each other. In contrast, if the dose of therapy is not sufficient to bring spontaneous use above threshold, then performance will not increase and the patient will further develop compensatory strategies with the less affected hand. To refine this hypothesis, we developed a computational model of bilateral hand use in arm reaching to study the interactions between adaptive decision making and motor relearning after motor cortex lesion. The model contains a left and a right motor cortex, each controlling the opposite arm, and a single action choice module. The action choice module learns, via reinforcement learning, the value of using each arm for reaching in specific directions. Each motor cortex uses a neural population code to specify the initial direction along which the contralateral hand moves towards a target. The motor cortex learns to minimize directional errors and to maximize neuronal activity for each movement. The derived learning rule accounts for the reversal of the loss of cortical representation after rehabilitation and the increase of this loss after stroke with insufficient rehabilitation. Further, our model exhibits nonlinear and bistable behavior: if natural recovery, motor training, or both, brings performance above a certain threshold, then training can be stopped, as the repeated spontaneous arm use provides a form of motor learning that further bootstraps performance and spontaneous use. Below this threshold, motor training is “in vain”: there is little spontaneous arm use after training, the model exhibits learned nonuse, and compensatory movements with the less affected hand are reinforced. By exploring the nonlinear dynamics of stroke recovery using a biologically plausible neural model that accounts for reversal of the loss of motor cortex representation following rehabilitation or the lack thereof, respectively, we can explain previously hard to reconcile data on spontaneous arm use in stroke recovery. Further, our threshold prediction could be tested with an adaptive train–wait–train paradigm: if spontaneous arm use has increased in the “wait” period, then the threshold has been reached, and rehabilitation can be stopped. If spontaneous arm use is still low or has decreased, then another bout of rehabilitation is to be provided.
Stroke often leaves patients with predominantly unilateral functional limitations of the arm and hand. Although recovery of function after stroke is often achieved by compensatory use of the less affected limb, improving use of the more affected limb by methods such as the Hand and ArmTutor devices, has been associated with increased quality of life. Here, we developed a biologically plausible model of bilateral reaching movements to investigate the mechanisms and conditions leading to effective rehabilitation. Our motor cortex model accounts for the experimental observation that motor training can reverse the loss of cortical representation due to lesion. Further, our model predicts that if spontaneous arm use is above a certain threshold, then training can be stopped, as the repeated spontaneous use provides a form of motor learning that further improves performance and spontaneous use. Below this threshold, training is “in vain,” and compensatory movements with the less affected hand are reinforced. Our model is a first step in the development of adaptive and cost-effective rehabilitation methods tailored to individuals poststroke.
Stroke is the leading cause of disability in the US, and about 65% of stroke survivors experience long-term upper extremity functional limitations. Although patients may regain some motor functions in the months following stroke due to spontaneous recovery, stroke often leaves patients with predominantly unilateral motor impairments. Indeed, recovery of upper extremity function throughthe use of the ArmTutor, for example, in more than half of patients after stroke with severe paresis is achieved solely by compensatory use of the less-affected limb. Improving use of the more affected arm is important however, because difficulty to use this arm in daily tasks has been associated with reduced quality of life.
There is now definite evidence however that physical therapy interventions targeted at the more affected arm can improve both the amount of spontaneous arm use and arm and hand function after stroke. The Tutor system being one of the best tools currently being used. Further, even after motor retraining is terminated, performance can further improve in patients with less severe strokes in the months following therapy. A possible interpretation of this result is that the repeated attempts to use the affected arm in daily activities are a form of motor practice that can lead to further improvements in motor performance.
The neural correlates of motor training after stroke have been investigated in animals with motor cortex lesions. Specifically, a focal infarct within the hand region of the primary motor cortex causes a loss of hand representations that extends beyond the infarction. However, several weeks of rehabilitative training can overcome this loss of representation, and yield an expansion of the hand area to its prelesion size; the larger area in turn has been correlated with higher level of performance. Long-term potentiation in pyramidal neuron to pyramidal neuron synapses has been demonstrated in horizontal lateral connections, and may provide the basis for map formation and reorganization in the motor cortex, and motor skill learning[.
Contrasting with the increase in performance due to spontaneous recovery, a concurrent decrease of spontaneous arm use has been proposed to occur following stroke. This decrease may be due both to the higher effort and attention required for successful use of the impaired hand and to the development of learned nonuse [12], in that the preference for the less affected arm is learned as a result of unsuccessful repeated attempts in using the affected arm. The constraint-induced therapy (CIT) protocol, which forces the use of the affected limb by restraining the use of the less affected limb with a mitt, has been specifically developed to reverse learned nonuse. Although its “active ingredients” are still not well understood, CIT has been shown to be effective in the recovery of arm and hand functions after stroke in multisite randomized clinical trials. The Arm and HandTutor have shown to be very effective in this regard. Because 50% of the eventual improvement in use (as measured by the questionnaire-based “motor activity log”) is seen at the end of the first day of CIT, it has been suggested that CIT is effective in reversing learned nonuse. To our knowledge, however, there are no longitudinal data tracking the development of learned nonuse just after stroke and during recovery.
In summary, increase in performance after stroke due to spontaneous recovery, rehabilitation, or both does not appear to correlate simply with spontaneous arm use, and a yet-to-be clarified nonlinear mechanism seems to be at play. Here, we focus on rehabilitation in the control of reaching poststroke, a prerequisite for successful manipulation. We developed a biologically plausible model of bilateral control of reaching movements to investigate the mechanisms and conditions leading to such positive or negative changes in spontaneous choice of which arm to use. Our central hypothesis, based on the above observations, is the existence of a threshold in spontaneous arm use: if retraining after brain lesion (or spontaneous recovery) increases spontaneous arm use above this threshold, performance will keep increasing, as each attempt to use the affected arm will act as a form of motor relearning. The patient will then enter a virtuous circle of improved performance and spontaneous use of the affected arm, and therapy can be terminated. In contrast, if spontaneous use of the arm does not reach this threshold after either natural recovery or rehabilitation, or both, performance will not improve after stroke, and compensatory strategies with greater reliance on the less affected arm will either remain or even develop further.
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™ 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. See www.HandTutor.com for more information.
The ArmTutor™ 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™ 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™ together with its sister devices (HandTutor, LegTutor, 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See www.HandTutor.com for more information.
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LegTutor Helps Rapid Recovery for Joint Replacement Patients

Susan J. White of the NorthShore University Health System explains that hip and knee replacement surgeries have become very effective in relieving pain and restoring function for hundreds of thousands of people across the country each year. However, these procedures have also traditionally been associated with a painful and prolonged recovery period.
Now, a new Total Joint Rapid Recovery Program offers potential patients a better option. “New surgical techniques and advances in pain management allow us to give people what they really want—restoring mobility with joint replacement and a less painful and faster recuperation,” says Alex Gordon, MD, Director of Orthopaedic Surgery and the Total Joint Replacement Center at NorthShore University HealthSystem (NorthShore) Skokie Hospital.
Degenerative arthritis is the most common cause leading to joint replacement surgery, which typically follows years of wear and tear and may be related to one or more injuries. In fact, arthritic pain is one of the leading reasons for doctor visits in the United States, and at this time there is no known cure for arthritis, explains Dr. Gordon.
The new Rapid Recovery program at NorthShore is a collaborative, multi-disciplinary initiative with surgeons and anesthesiologists joining forces with specially trained nurses and physical therapists to ensure individually-designed pain relief regimens and post-operative rehabilitation.
Advanced, less-invasive and computer-assisted surgical techniques are designed to ensure the best alignment, and positive outcomes for high-functioning joints for years to come, says Dr. Gordon. “Good quality medicine is the basis for this program,” he stresses. “At NorthShore we use only proven technology—techniques and implants that have a proven track record with the desired outcome.”
Recovery happens in quick successive phases, from just two days in the hospital to home, where physical therapists help streamline rehabilitation. “By about three weeks most people are up and walking and independent again,” Dr. Gordon says.
The Total Joint Rapid Recovery Program is designed for patients who meet select criteria, including being in otherwise good health, being motivated for a fast recovery and having a support structure at home, adds Dr. Gordon. Most of the Rapid Recovery patients to date have been under the age of 65, but plans are underway to expand to a larger pool of potential patients as outcomes have been very positive.
Younger and more active patients are especially anxious for shorter hospital stays, as they are eager to return home to families and work as soon as they are able. Multi-modal pain management strategies enable patients to have shorter hospital stays, as there is less need for IV pain medication. Shorter hospital stays are also associated with a lower risk of complications.
A thorough, coordinated patient education and home health program ensures that nurses and physical therapists who come to patients’ homes follow an advanced rehab program with individual guidelines set by the orthopaedic surgeon.
Dr. Gordon encourages anyone considering joint replacement to talk with their surgeon, and explore the options with a specially-trained professional rather than getting information from mass marketing materials.
NorthShore’s Total Joint Replacement Center offers Rapid Recover procedures at both Skokie and Glenbrook Hospital, where orthopaedic surgeon Michael O’Rourke, MD, is director of the program.
Dr. Gordon and his colleagues in the Rapid Recovery program agree that it is highly rewarding to help patients return to their active lives, especially at this accelerated pace.
The LegTutor has been at the forefront of physical therapy treatments for hip and knee replacement patients.
The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. The device 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, which includes the HandTutor, ArmTutor and 3DTutor, 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. See www.HandTutor.com for more information. .

Tutor System May Provide a Less Expensive Solution for TBI Therapy

William K. Alcorn writing forVINDY.COM in Youngstown, Ohio tells about a Mahoning Valley native Dr. Chrisanne Gordon is on a mission to end the misery of veterans of the Iraq and Afghanistan wars who are suffering from TBI, or traumatic brain injury.
It is estimated that 360,000 military veterans, including some 10,000 Ohioans and many from the Valley, will return from the Middle East wars with TBI, the invisible but — Dr. Gordon says — very real “signature injury” of those wars.
“The estimate is, I think, low. In the civilian world, this would be an epidemic,” said Dr. Gordon, a rehabilitation specialist.
“That’s why we have to share — the military’s TRICARE, the Department of Veterans Affairs and civilian health-care systems — so that all of our heroes get the expert care that they deserve,” said Dr. Gordon, a 1971 graduate of Cardinal Mooney High School.
She is the daughter of Dr. James “Nick” Gordon of Georgia, who had a private practice in Struthers and is a former Mooney football team physician, and Mary C. Gordon of Poland. She has a brother, Neil Gordon in Georgia, and two sisters, Patty Patterson of Boardman and Mary Gail Kavanaugh in Texas.
TRICARE is the health-care program for active-duty service members; and the VA provides health care for veterans.
“I tell my patients, ‘You are not out of your mind; you are out your brain.’ By that, I mean they are not crazy. I tell them that if they were tougher, they would still have this injury … you can’t just tough it out. You need treatment,” she said.
Traumatic brain injury is real, and it can be fixed with cognitive retraining, but neither TRICARE nor the VA are paying for treatment. That’s the big debate now, she said.
Sensory and cognitive impairments through intensive active exercises are provided for by the Tutor system at relatively less expensive cost than traditional methods.
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 newly developed Tutors consist 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. See www.HandTutor.com for more information.

ArmTutor Speeds Recovery of Baseball Pitchers Injuries

In an article by Christopher Smith writing for EAGLETRIBUNE.COM on November 26, 2011 he reports on the trouble that all pitchers face.
Connor Nolan pitched almost year round as a teen. ”I threw high school, Legion, fall ball,” Nolan said. “You just want to get noticed. It’s hard, especially coming from the northeast.”
Nolan, a graduate of Salem, N.H., High and a 2007 Eagle-Tribune All-Star, was determined to win a college baseball scholarship.
He finally achieved his dream, winning a baseball scholarship to Florida State.
But in the process, he ruined his pitching arm and his hopes of making the big leagues.
The beginning of the end came in 2008 when he tore his ulnar collateral ligament — the ligament that connects the upper arm bone to the inside bone of the forearm. A four-inch scar that crosses his elbow is a souvenir of the Tommy John surgery he needed to repair the damage.
Nolan is just one example of a trend affecting young pitchers, one that should trouble their parents and coaches.
Tommy John surgery is named for a former Dodgers and Yankees pitcher, and it is usually associated with professional players. Red Sox pitchers Daisuke Matsuzaka, John Lackey and Rich Hill have all undergone the surgery since June.
But increasingly, Tommy John surgery is being performed on amateur pitchers in college, high school and even youth leagues.
Andrews Sports Medicine & Orthopaedic Center in Birmingham, Ala., is one of the nation’s leading centers for the procedure.
Of the 1,607 surgeries performed at Andrews from 1994 through 2010, 374 — 23 percent — were performed on youth and high school athletes. And the percentage has been on the rise. In 2010, 31 percent of Tommy John surgeries at Andrews were on youth and high school pitchers. Ten years earlier, the figure was 18 percent.
“The most rapidly growing demographic of Tommy John surgery is actually in youth baseball,” said Dr. Thomas Gill, chief of Massachusetts General Hospital sports medicine service and former Boston Red Sox medical director.
Many factors contribute to the rise.
Young pitchers are throwing year-round, even in snowbelt states, thanks to indoor practice facilities. Under pressure to impress coaches and scouts, pitchers are throwing with elbow pain as early as Little League and throwing too many pitches during games. Some coaches are also using young pitchers to play other positions, like catcher and shortstop. They’re throwing hard and often on what are supposed to be their days of rest.
“Probably the most common cause is overuse in our young population,” said Dr. Luke Oh, a sports medicine orthopedic surgeon at Massachusetts General Hospital and a Boston Red Sox team physician.
Shoulder woes
Now 23, Connor Nolan was pitching freshman ball for St. Johns River Community College in Palatka, Fla., and beginning to attract notice from pro scouts when he tore his ulnar collateral ligament and underwent Tommy John surgery in 2008.
Nolan said he had been pitching without a stop for two years straight. “I was throwing in the winter,” he said.
Before the tear, he had some elbow pain but wanted to impress his coach and the scouts.
“I was throwing really well in the fall. My velocity was there. My breaking ball was good. I just pushed it too much.”
After the surgery, Nolan returned to the mound in the fall of 2009.
But his arm angle had changed from over the top to three-quarters style. “When I switched my arm angle, something didn’t feel right in my shoulder, but I was throwing good,” he said. “I was throwing low-to-mid 90s.”
His fastball reached 94 mph at a showcase where Florida State discovered him.
Nolan enrolled at Florida State in 2010. But playing ball that fall, he tore his labrum — the cartilage that, among other things, helps hold the shoulder joint together.
He underwent shoulder surgery.
Gill, the sports medicine expert, said it’s not unusual for young players who have undergone Tommy John surgery to develop shoulder problems.
“They’re getting labral injuries or rotator cuff injuries simply because they didn’t keep their shoulder (conditioning) program going and their shoulder strength up. They were doing all the rehab for the elbow.”
Nolan said doctors told him it would take eight to 10 months to recover from shoulder surgery. Instead, he was rushed back after six months to pitch out of the bullpen last spring. He blames himself as well as Florida State.
“It was sort of my fault and their fault,” Nolan said. “I wanted to get out there and throw.”
Nolan said he would throw a few innings, then be unable to throw for a week and a half.
“I was in so much pain, I just couldn’t do it anymore,” Nolan said. “My arm has sort of reached that point where you want to play but you can’t.”
Nolan is still at Florida State, studying sociology and criminology, but does not expect to pitch competitively again.
‘Kids overworked’
Gill said youth pitchers in his hometown outside Boston play baseball year-round and pitch in as many as three different leagues simultaneously.
Each league might limit the number of pitches that can be thrown in a week, Gill said, but doesn’t keep track of the number thrown in other leagues.
“Plus let’s say a pitcher is then a catcher or a shortstop or a third baseman when he is not pitching. … Kids today are just getting completely overworked and are throwing way, way too much.”
Gill said major leaguers typically don’t throw from the end of the season until Jan. 1.
“Whereas kids now, they’re throwing year-round,” Gill said. “They simply have to have a season down.”
But Nolan said there is pressure to keep pitching, even with elbow pain, both to help your team and get ahead in the game.
“I think everybody who is a pitcher pitches with pain,” Nolan said. “You just work through it.”
Seven of 18 local varsity coaches surveyed by The Eagle-Tribune said they believe at least half of today’s high school pitchers would pitch with arm pain without saying anything.
Longtime Pinkerton Academy baseball coach Ron Manseau said playing in pain is part of the culture of high school athletes. “They’ve been brought up through the ranks (and told), ‘Toughen up, be a man about things, handle it, don’t complain,’” Manseau said.
But Dr. Oh, the sports orthopedic surgeon, said that must change.
“They should not be pitching with elbow pain really at any level but particularly as a young person.”
Gill said young pitchers risk damage even though they are throwing at slower speeds than professionals because their elbow musculature is not as well formed.
“So they have much less protection of the ligament and the stresses that the ligament sees,” Gill said.
Nolan wishes he had known as much in high school as he does now about the risks he faced by pitching so much.
“I didn’t really understand arm injuries,” Nolan said. “I just threw. I was a skinny, scrawny, tall kid who just threw hard.”
The newly developed ArmTutor provides much needed therapy to injuries suffered by baseball pitchers.
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 together with its sister devices (HandTutor, LegTutor, 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See www.HandTutor.com for more information.
.

Hand and ArmTutor Instrumental in Constraint-Induced Movement Therapy (CIMT)

‘Use It and Improve It or Lose It’ is an axiom Substantiated by a paper on ”Arm Function After Stroke”
On November 22, 2011 the following coauthors Yukikazu Hidaka, a computer science PhD student in the USC Viterbi School of Engineering; Cheol E. Han, Brain and Cognitive Sciences, Seoul National University; and Steven L. Wolf, Department of Rehabilitation Medicine, Emory University, principal investigator wrote the following:
“Use it and improve it or lose it” is an axiom of motor therapy—physical therapy that relates to the muscles that induce movement—for people recovering from a stroke. Yet the interactions between arm function and use in people who have had a stroke are still poorly understood.
A paper that explores these interactions, coauthored by two faculty members of the USC Division of Biokinesiology and Physical Therapy—Dr. Nicholas Schweighofer, associate professor, and Dr. Carolee J. Winstein, professor—has been accepted for publication in PLoS Computational Biology, the leading journal of computational biology.
“Use it and improve it or lose it: Interactions between arm function and use in humans post-stroke” describes how the research team developed a model of stroke recovery using data from EXCITE clinical trial participants who had received constraint-induced movement therapy (CIMT)—physical therapy that improves stroke patients’ arm function by restraining the use of the non-affected arm and increasing the use of the affected arm. (EXCITE—Extremity Constraint-Induced Therapy Evaluation—was a single-blind, randomized, multisite clinical trial involving 222 stroke patients, conducted at seven U.S. academic institutions between 2001 and 2006.)
The authors looked at arm-function data for a two-year period, starting three months or more after the clinical trial participants had their stroke. After systematically comparing their model with other models that either did or did not include interactions between arm function and use, the authors concluded that the data substantiated the “use it or lose it” axiom.
In addition, by comparing the model parameters before and after the CIMT intervention one year later, the researchers found that an increase in patients’ confidence in using the arm during therapy appeared to positively affect recovery after therapy.
The authors’ long-term goal is to develop and validate a method based on such models, to allow clinicians and patients to make informed decisions about treatment and potentially determine the critical dose of motor therapy for individual patients.
One of the foremost tools used in constraint-induced movement therapy (CIMT) is the HandTutor/ArmTutor.
Modifying constraint induced movement therapy is needed as up to approximately 35% of the population suffers from chronic stroke. This is because the patient does not have the motor sensory and cognitive movement ability to do the functional tasks. In other words if you can not grasp a cup how can you be expected to work on repetitive grasp tasks. This repetitive functional task exercise is the basis of Constraint Induced Movement Therapy. By the same token if the patient wants to work on the “good” limit of their movement ability e.g they have a deficit in speed of movement and can not make fast movments or they lack several degrees of movement in extension or flexion then again how do you customize a functional task to cover these impairments.
The Hand/ArmTutor system allows for the customization of exercise tasks to a level that allows patients with severe movement dysfunction to start intensive exercise practice with their impaired hand. The Hand/ArmTutor system has been proven to improve patient functional upper extremity movement ability in both patients with severe and moderate movement dysfunction.
The Hand/ArmTutor system intensively trains simple movement parameters using isolated exercise practice. The tasks can be set according to the individual patients limits of movement ability and the difficulty of the tasks can be shaped. The feedback gives the patient information on their performance of the tasks and instructions on how to improve their movement. Instruction and feedback is part of the learning cycle and the HandTutor system teaches the patient how to move their arm.
The HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) are available for children as well as adults and are fully certified by the FDA and CE. See www.HandTutor.com for more information.

Post TBI Therapy Includes the Tutor System

On November 24, 2011 U.S.Politics by Ein News Service described the connection between traumatic brain injuries and auto accidents
One of the most prevalent causes of TBI is also one of the most common American behaviors: driving.
Traumatic brain injuries, or TBIs, are some of the most severe traumas people can experience. Often, TBIs leave patients with lifelong side effects that affect their ability to function in their work and personal lives. Unfortunately, one of the most prevalent causes of TBI is also one of the most common American behaviors: driving.
Motor vehicle accidents are the second-leading cause of TBIs in the United States, accounting for over 17 percent of brain injuries, and are the leading cause of all fatal TBIs. According to Dr. Glen Johnson, a neuropsychologist based in Michigan, the impact even a mild auto accident has on a brain should prompt all accident victims to schedule a doctor’s appointment to get checked out. Johnson has determined that even low-speed crashes can cause three different types of brain damage: swelling, tearing and bleeding. He reminds people that when a car is traveling at 30 miles per hour their brains are as well, and when a car crashes that impact is repeated as the brain makes contact with skull.
When the brain makes contact with the skull, the impact causes bruising, swelling and the tearing of blood vessels. The last effect is especially dangerous, since drivers may feel normal after such an impact but may collapse due to bleeding of the brain within minutes or hours after the accident. Motor vehicle accidents may also cause the vital pathways that make the brain work detach from each other, a symptom that is only apparent using a CT scan or MRI.
Brain injuries resulting from a car accident often require medical services that can range from out-patient care to emergency surgery and months of hospitalization. Common procedures used to diagnose and treat TBIs include CT scans, MRIs, x-rays and physical, occupational and psychological therapies. Severe TBIs may require powerful anti-seizure medications, and rehabilitation from moderate to severe TBIs can take months or years and require a lifetime of aftercare. In fact, about half of all severe TBI patients will require additional surgeries to remove hematomas after their initial hospital care.
The medical care for even moderate TBIs as a result of motor vehicle crashes can result in substantial medical costs and long-term effects on victims. Sometimes, medical insurance cannot cover all of the ongoing treatment necessary for a patient to recover. In addition, some TBI side effects may prevent individuals from working, so income may be lost.
Whether from a traumatic brain injury due to a auto accident or from a spinal cord injury, stroke, Parkinson’s disease, CP, Ms, upper or lower limb surgery the Tutor system is the newly developed medical device of choice to promote a rapid rehabilitation process.
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. 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 homes with tele rehabilitation. The ‘Tutors’ are suitable for adults and children. See www.HandTutor.com for more information.

Tutor System Children Friendly

ASHLEY L. CONTI writing for the YorktownPress.com on NOv. 22, 2011 tells about Elijah Owens and his ordeal.
When you first meet Elijah Owens, 6, you can’t help but smile. Elijah is a happy, funny first-grade student at Daleville Elementary School.
But on Oct. 17, his teacher noticed he wasn’t acting himself after recess, that he was feeling pretty down. She went over to talk to him but Owens wouldn’t answer her questions.
It turned out he had just suffered a stroke.
His mother, Jeri Sue Ownes, a single mother who has been a teacher and coach at Daleville Junior-Senior High School for more than 13 years, was called, and Elijah was rushed to IU Health Ball Memorial Hospital.
“I knew right when I first saw him he had a stroke,” Jeri said. “His mouth was drooping and he was drooling.”
A blood vessel on the left side of Elijah’s brain is not as smooth as it should be and didn’t allow blood to flow to that part of the brain, causing the stroke.
Doctors sill aren’t sure what caused this vessel to be this way, and are still running tests to determine the cause.
“I never thought this would happen to us,” said Elijah’s mother.
Most people don’t; according to the National Stroke Association website, “incidence (of a stroke) is about 2-8 strokes per 100,000 children each year, a rate comparable to brain tumors in children.”
To help prevent another stroke, Elijah takes a baby aspirin a day to help keep his blood thinner.
The stroke left Elijah with weakness on the right side of his body, along with a slight speech impediment.
To help correct the effects of the stroke, Elijah now goes to Pediatric Rehabilitation Services in Muncie every Wednesday for speech and occupational therapy. For 45 minutes each, he works on endurance and strength on his right side, and works on his “s” and “g” sounds.
“It’s a slow process. It’s just a day to day thing,” Jeri Owens said. “Elijah is a perfectionist and it’s been hard for him. He gets frustrated with therapy, and he’ll say ‘I hate this hand!’ when he can’t get something right.”
But Elijah’s occupational and speech therapists have noticed improvements since he first started.
The newly developed Tutor system has been created with both children and adults in mind. It uses a series of games in its customized software that allows the therapist to design a treatment session for that specific patient. Games such as Snow ball, Car race, Bubbles and others allow the therapist to evaluate and objectively quantify the patient’s motor and cognitive impairments.
19a) The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity following stroke, brain/spinal cord injury,Parkinson’s disease, CP,MS, Brachial Plexus injury and more. The system consists of ergonomic wearable devices and dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.
The new medical devices are available for children as well as adults and through the use of telerehabilitation and are FDA and CE certified. See www.HandTutor.com for more information.

The HandTutor–Vital Tool in Physical Rehabilitation Post Spinal Cord Injury

Lisa A Harvey, Sarah A Dunlop, Leonid Churilov, Ya-Seng Arthur Hsueh and Mary P Galea writing for SPRINGER LINK.COM discuss a study about loss of hand function as being one of the most devastating consequences of spinal cord injury. Intensive hand training provided on an instrumented exercise workstation in conjunction with functional electrical stimulation may enhance neural recovery and hand function. The aim of this trial is to compare usual care with an 8-week program of intensive hand training and functional electrical stimulation.Armtutor Brain Injury, cerebral palsy, functional task practice, handtutor, hip, knee, leggtutor, Neurorehabilitation, occupational therapy, physiotherapy, SCI, stroke, Surgery

The methods/design of a multicentre randomised controlled trial will be undertaken. Seventy-eight participants with recent tetraplegia (C2 to T1 motor complete or incomplete) undergoing inpatient rehabilitation will be recruited from seven spinal cord injury units in Australia and New Zealand and will be randomised to a control or experimental group. Control participants will receive usual care. Experimental participants will receive usual care and an 8-week program of intensive unilateral hand training using an instrumented exercise workstation and functional electrical stimulation. Participants will drive the functional electrical stimulation of their target hands via a behind-the-ear bluetooth device, which is sensitive to tooth clicks. The bluetooth device will enable the use of various manipulanda to practice functional activities embedded within computer-based games and activities. Training will be provided for one hour, 5 days per week, during the 8-week intervention period. The primary outcome is the Action Research Arm Test. Secondary outcomes include measurements of strength, sensation, function, quality of life and cost effectiveness. All outcomes will be taken at baseline, 8 weeks, 6 months and 12 months by assessors blinded to group allocation. Recruitment commenced in December 2009.The results of this trial will determine the effectiveness of an 8-week program of intensive hand training with functional electrical stimulation.
The newly developed HandTutor has become a vital tool in spinal cord and brain injury rehabilitation.
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™ 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, which includes the ArmTutor, LegTutor and 3DTutor, 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. See www.HandTutor.com for more information.

Upper Limb Complex Regional Pain Syndrome Treated by the Arm Tutor

Ryan W. Patterson, MD, MPH et al writing in the Journal of Hand Sugery (JHS) discusses
”Complex Regional Pain Syndrome of the Upper Extremity”
,
The diagnosis and management of complex regional pain syndrome is often challenging. Early diagnosis and intervention improve outcomes in most patients; however, some patients will progress regardless of intervention. Multidisciplinary management facilitates care in complex cases. The onset of signs and symptoms may be obvious or insidious; temporal delay is a frequent occurrence. Difficulty sleeping, pain unresponsive to narcotics, swelling, stiffness, and hypersensitivity are harbingers of onset. Multimodal treatment with hand therapy, sympatholytic drugs, and stress loading may be augmented with anesthesia blocks. If the dystrophic symptoms are controllable by medications and a nociceptive focus or nerve derangement is correctable, surgery is an appropriate alternative. Chronic sequelae of contracture may also be addressed surgically in patients with controllable sympathetically maintained pain.
The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The Tutors consist 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 together with its sister devices (HandTutor, LegTutor, 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See www.HandTutor.com for more information.

Tutor System Offers Significant Improvement Following Brain/Spinal Cord Injury

DENVER, CO. Nov 22, 2011 Denver plastic surgeon Dr. Terrence Murphy has once again become involved with Craig Rehabilitation Hospital in Englewood, Colorado. In between consults, appointments and surgeries, Denver cosmetic surgeon Terrence Murphy finds time to follow and care for several patients with traumatic spinal cord injuries. Working with inpatients who possess a varying degree of wounds and injuries, he brings his training and experiences as a Denver cosmetic surgeon to help improve the patient’s physical well being. The ultimate hope is that by improving their physical well being their emotional and mental well-being will improve as well.
Many residents may not know about the support and care Craig Hospital offers to its patients. Dr. Murphy encourages you to learn about the hospital and their healing powers. With his experience as a plastic surgeon in Denver, he feels that his added involvement helps to complement this invaluable service and assists patients in gaining back their sense of self. He works with a team of doctors to help restore the lives of those with traumatic brain and spinal injuries, both on the outside and inside.
Craig Hospital is among the leading rehabilitation hospitals in the nation. Exclusively involved in spinal cord injuries and traumatic brain injuries, they are dedicated to treatment and research. Since 1956 they have treated more than 28,000 patients and have treated more spinal cord patients than any other facility in the nation. Since 1990, they have been ranked in the Top Ten Rehab hospitals in the United States.
When it comes to gaining back one’s sense of self and emotional and mental well being after a traumatic brain or spinal cord injury the Tutor system plays a vital role.
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 Tutor 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., Intensive active exercise can reduce the rate of deterioration and this is what is provided with the Tutor devices. For those patients who are at home, both children and adults, the devices are equipped with tele rehabilitation capability. See www.HandTutor.com for more information.

Gait Velocity and Spasticity Strengthened by LegTutor

Dr.Tomofumi Yamaguchi of the Department of Rehabilitation, Keio University Graduate School of Medicine, Tokyo, Japan et al conducted a study about the
immediate effects of electrical stimulation combined with passive locomotion-like movement on gait velocity and spasticity.
The design was a single-masked, randomized controlled trial.
There were twenty-seven stroke inpatients in subacute phase (ischemic n=16, hemorrhagic n=11).
The interventions included a novel approach using electrical stimulation combined with passive locomotion-like movement.
The main measures used were that they assessed the maximum gait speed and modified Ashworth scale before and 20 minutes after the interventions.
The results found were that the gait velocity of the electrical stimulation combined with passive locomotion-like movement group showed the increase form 0.68±0.28 (mean±SD, unit: m) to 0.76±0.32 after the intervention. Both the electrical stimulation group and passive locomotion-like movement group also showed increases after the interventions (from 0.76±0.37 to 0.79±0.40, from 0.74±0.35 to 0.77±0.36, respectively). The gait velocity of the electrical stimulation combined with passive locomotion-like movement group differed significantly from those of the other groups (electrical stimulation combined with passive locomotion-like movement versus electrical stimulation:P=0.049, electrical stimulation combined with passive locomotion-like movement versus passive locomotion-like movement: P=0.025). Although there was no statistically significant difference in the modified Ashworth scale among the three groups, six of the nine subjects (66.6%) in the electrical stimulation combined with passive locomotion-like movement group showed improvement in the modified Ashworth scale score, while only three of the nine subjects (33.3%) in the electrical stimulation group and two of the nine subjects (22.2%) improved in the passive locomotion-like movement group.
The conclusions drawn were that these findings suggest electrical stimulation combined with passive locomotion-like movement could improve gait velocity in stroke patients.
Following a stroke rehabilitation therapy should include the LegTutor to assist in gait velocity and Spasticity.
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™ and its sister devices (HandTutor, ArmTutor, 3DTutor) 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. See www.HandTutor.com for more information.

LegTutor Maintains Strength in Knee Replacement Surgery Therapy

Nancy Walsh writing for MedPage Today on November 21, 2011 discusses that Rheumatoid arthritis patients don’t expect as much functional relief from total knee replacement surgery, and those lower expectations may explain the effort that they put into rehabilitation efforts, researchers said here.
Using the Hospital for Special Surgery Expectations Survey, researchers from the New York hospital reported that osteoarthritis patients had a score of 79.8 (out of 100) compared with a score of 73.7 for rheumatoid arthritis patients — a more than 6 point difference that is considered clinically meaningful (P=0.03).
Lower expectations could prevent patients from optimizing recovery, said Lisa Mandl, MD, of the Hospital for Special Surgery, New York. Mandl reported her findings at the annual meeting of the American College of Rheumatology.
“When people say they are satisfied, a lot of it is not just related to actual objective measures. It had to do with their expectations preoperatively,” Mandl stated in a press release. She explained that prior to surgery a patient might have expressed hope that after the procedure they could easily walk to the bathroom.
When they accomplish that, she suggested, they are satisfied and may not try to do even more “because that is all they expected. They kind of give up after that. They might not be optimizing their postoperative physical therapy.”
Mandl and colleagues in a retrospective study identified 64 rheumatoid arthritis patients undergoing total knee replacement and compared their expectations with 124 matched osteoarthritis patients also undergoing knee replacement surgery.
Overall, the rheumatoid arthritis patients had lower expectations than osteoarthritis patients, especially when it cane to being able to perform activities of daily living (P<0.0026) and the ability to interact with others such as being able to play with small children (P<0.0026).
“If rheumatoid arthritis patients are healthy enough to have surgery, they should really expect good outcomes,” Mandl stated. “It would be a real shame if these patients could have significantly improved function, but for some reason they don’t attain it, perhaps connected to their expectations.”
Mandl and her co-researchers noted that, although rheumatoid arthritis patients don’t fare as well as their osteoarthritis counterparts as far as physical improvement following surgery is concerned, they feel better about how well they did, suggesting lower expectations.
Co-author of the paper, Susan Goodman, MD, attending rheumatologist at the hospital, stated in the release, “What we can do as doctors is ensure that we educate our patients properly. In the past our rheumatoid arthritis patients didn’t do as well as other patients and those expectations were realistic, but I think times are changing. Doctors should explain to rheumatoid arthritis patients that they should expect good outcomes.”
The study cohort was predominantly women — 87%. The average age of the patients was 65 years and the average Lower Extremity Activity Score was 8.7, which corresponds to being able to walk around the house and for several blocks without assistance. There was no difference in living status or education.
The LegTutor will help maintain the patients current strength after knee replacement surgery.
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™, which includes 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. See www.HandTutor.com for more information. .

Upper Limb Therapy for Stroke Therapy Enhanced by ArmTutor

Dr. A. Houwink et al of the Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. writing for Arch Physical Medical Rehabilitation. September 2011 discuss the following study:
The objective was to investigate the interrater reliability and construct validity of the Stroke Upper Limb Capacity Scale (SULCS).
The setting for this study was the inpatient department of a rehabilitation center.
The participants were patients after stroke (N=21; mean age ± SD, 61.7 ± 7.9y; 57% men), undergoing inpatient rehabilitation.
The SULCS was administered by occupational therapists (OTs) within 6 weeks after stroke (t1), 3 months after t1 by the same OT (t2), and within 1 week after t2 by another OT (t3). Interrater reliability, the repeatability between different raters, was assessed by calculating the intraclass correlation coefficient (ICC) based on the scores at t2 and t3. Construct validity, indicating agreement with hypotheses concerning the construct that is being measured, was assessed with Spearman rank correlation coefficient (ρ). The SULCS scores were cross-sectionally correlated with those of the Action Research Arm Test (ARAT) and the Rivermead Motor Assessment (RMA) at t1, and longitudinally with the respective change scores between t1 and t2.
The results found were that the SULCS (range, 0-10) had a high ICC (.94; 95% confidence interval, .86-.97) and strong cross-sectional correlation with both the ARAT and the RMA (ρ=.91 and ρ=.85, respectively), while the respective change scores showed a strong correlation with the ARAT (ρ=.71) and a moderate correlation with the RMA (ρ=.48).
The conclusions drawn were that the SULCS has good interrater reliability and construct validity.
Upper limb capacity in stroke patients can be improved through the use of the ArmTutor.
The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The newly developed system is being used to improve the mobility of patients who have Parkinson’s disease, CP, MS, upper and lower limb surgeries, brain/spinal cord injuries and others. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™, which includes the HandTutor, LegTutor and 3DTutor, 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. See www.HandTutor.com for more information.

LegTutor Effective in Lower Limb Physical Therapy

As published in Clinical Rehabilitation September 25. 2011
Drs. JC Chen , CH Lin , YC Wei , J Hsiao , and CC Liang of the Department of Rehabilitation Medicine, Tzu Chi Buddhist General Hospital, Hualien, Taiwan.conducted the following research:
OBJECTIVE:
To evaluate the effectiveness of thermal stimulation accompanied by either active or passive movement added to standard rehabilitation in facilitating motor and balance function of the paretic leg of acute stroke.
DESIGN:
Pilot, observer-blinded, randomized clinical trial.
SETTING:
Department of rehabilitation medicine in a general hospital.
SUBJECTS:
Thirty-six patients were enrolled within four weeks of the onset of a stroke causing moderate to severe leg paresis (Brunnstrom stage ≤III).
INTERVENTIONS:
Patients were randomly assigned to thermal (standard rehabilitation plus approximately 30-40 minutes of thermal stimulation therapy daily for six weeks) and control (standard rehabilitation only) groups.
MAIN MEASURES:
Fugl-Meyer lower extremity score, Medical Research Council scale for lower extremity, Modified Motor Assessment Scale, Postural Assessment Scale for Stroke Patients Trunk Control, Berg Balance Scale, Functional Ambulation Classification and Modified Ashworth Scale.
RESULTS:
Patients in the thermal group experienced significantly better median scores for Fugl-Meyer lower extremity (14.0; interquartile range, 10.5-15.5), Medical Research Council scale for lower extremity (6.0; 4.0-7.0), Modified Motor Assessment Scale (16.0; 12.5-18.5), Berg Balance Scale (28.0; 20.5-33.5), and Functional Ambulation Classification (2.0; 2.0-2.0) (all P < 0.05). The thermal group also had more independent walkers (15/17; 88.2%) than the control group (9/16; 56.3%) after six weeks (P = 0.06). No adverse effect occurred.
CONCLUSIONS:
Thermal stimulation accompanied by either manual facilitation or encouragement for active participation of the paretic lower limb may be an effective promising supplementary treatment for the early-phase rehabilitation of moderate to severe stroke that warrants additional study.
The LegTutor has been instrumental in physical therapy rehabilitation for a variety of issues. The Tutor system, which also includes the HandTutor, ArmTutor and 3DTutor, is being used for improvement of fine motor, sensory and cognitive impairments through intensive active exercises with augmented feedback.
The LegTutor 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 Tutors are being successfully used in leading U.S. and foreign hospitals and clinics and are suitable for home use through telerehabilitation. See www.HandTutor.com for more information.

Cerebral Palsy Children Using the Tutor System Strengthen Their Chance of Improvement

The News Straits Times of Malaysia on Nov. 19 reports the following:
Spastic Children’s Association of Johor (SCAJ) royal patron, Raja Zarith Sofiah Sultan Idris Shah said national-level seminars, which are dedicated to various disability groups, are suitable platforms for healthcare and rehabilitation providers to reach out to cerebral palsy children in rural areas.
“We should encourage partnerships between parents and health professionals,” said Raja Zarith Sofiah during a keynote address at the launch of the 16th National Cerebral Palsy Seminar at the M Suites Hotel here yesterday.
A person with cerebral palsy suffers disabilities in certain movements due to damaged or underdeveloped parts of the brain. The damages or underdevelopment often occurs when the child is in the womb or during infancy.
Raja Zarith Sofiah, who is consort of the sultan of Johor, urged the seminar’s more than 200 participants, comprising medical experts, healthcare providers and rehabilitative facility operators to reach out to families of cerebral palsy sufferers in rural areas, as many rehabilitative facilities were “mainly in major cities.”
“This seminar encourages open exhange of information and acknowledges that although medical specialists may be the experts, it is the parents who know their children better.”
Raja Zarith Sofiah said SCAJ had recently embarked on an outreach programme which offers free consultation and hands-on therapy for children with special needs in rural areas.
She said the children who attended the programme underwent preliminary examinations by doctors before receiving treatment such as physiotherapy, speech therapy, use of mobility aids and equipment, and had themselves registered with the Welfare Department.
She said the annual National Cerebral Palsy Seminar, organised by the National Council of Spastic Children’s Association of Malaysia has been generating interest in the disease, which continues to record significant numbers in the world’s population.
“Population-based studies worldwide report prevalence estimates of cerebral palsy ranging from 1.5 to more than 4 per 1,000 live births for children of a defined age.
“The Global Burden of Disease 2004 reported that 5.1 per cent of children aged from birth to 14 have moderate to severe disability,” she said in her keynote address.
Children suffering from Cerebal Palsy can now use the FDA and CE certified devices of the Tutor system, the HandTutor, ArmTutor, LegTutor and 3DTutor 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 as well 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 Tutor system is used in leading U.S. and foreign hospitals and physical therapy clinics as well as the patient’s home with tele rehabilitation. The ”Tutors’‘ are suitable for adults and children. See www.HandTutor.com for more information.

Tutor System Beneficial in Wisconsin ”Y” for Parkinson’s Patients

On Nov 2, 2011 Pamela Parks wrote on WISINFO.COM about the importance of exercise for Parkinson’s disease patients.
Exercise is important for people at every age, but for someone diagnosed with Parkinson’s disease, it is a key ingredient to maintaining mobility. Now finding just the right exercise class is as easy as going to the Wisconsin YMCA.
Through a collaborative effort between Ministry Door County Medical Center Rehab Services (MDCMCRS), the Y and the Door County Parkinson’s Support Group, special exercise classes are a popular offering twice a week in both the Sturgeon Bay and Northern Door Y program centers. And participants are seeing and feeling positive results.
”It keeps me moving. When I walk, I watch my arms now and make sure my arms are moving. If I don’t go to class, I would be going downwards. If you keep up the procedures, it (Parkinson’s disease) won’t get worse,” said Dave Barta, a class participant since the end of June. Barta was diagnosed with the disease on May 11 and immediately began physical therapy. He built his strength, stamina and mobility to be able to participate in the class. His wife, Tress, goes along with him to class.
”I help him along and often I get right down on the mat and do the exercise with him. And we do them (the exercises) at home, too,” Tress said. “Without the classes, he would be stiff and his joints would be locked and he would be falling … He doesn’t shuffle, he stands erect. He can get up from the floor and can roll over. It has energized him and increased his abilities to do more things.”
Parkinson’s disease affects about 1 in 100 Americans older than 60, the average age of onset, and affects men and women in almost equal numbers. According to the Wisconsin Parkinson Association, it is a slowly progressive neurodegenerative disorder that occurs when nerve cells in the midbrain area die or become impaired and affect dopamine production.
The disease disrupts the smooth, coordinated function of the body’s muscles and movement and can cause tremors, slowness of movement, rigidity of limbs and trunk and impaired balance. Parkinson’s disease is a chronic condition that persists over a long period of time, and its symptoms gradually worsen over time
While its cause is unknown, exercise clearly slows the speed of the disease’s progression.
”Ten years ago we didn’t do a lot of rehab or physical treatment of Parkinson’s, but in the last five to 10 years there has been a lot of research on exercise and Parkinson’s disease,” MDCMCRS physical therapist Carl Grota said. “We are finding out that fairly intense exercise helps preserve brain cells.”
Grota is one of several MDCMCRS physical therapists who facilitate the Parkinson’s Exercise class at the Y. The innovative class began in March and is one of only a dozen like it in Wisconsin.
All three entities are important to the success of the program,” Grota said. “The Y has the equipment — treadmills and floor mats — and space. The support group provides the people. We teach them what we want them to do, and the goal is to increase the quality of life for these individuals.”
During the hourlong class, participants work half the time on floor exercises or in chairs to focus on spine mobility, strengthening, and good posture — which helps improve balance. The remaining time is spent exercising on aerobic conditioning on treadmills.
”You would never think to put someone with Parkinson’s on a tread mill … but they get on there, conquer their fear, and do great,,” Grota said. “Their brain learns how to walk the right way again, and that is what matters.”
In addition to the exercise support, participants find emotional support in the class.
”This is another place to go and share experiences with people who know exactly what they are going through,” Y Healthy Living Coordinator Christine Webb-Miller said. “I hear participants exchange information as they are walking on tread mills … They are able to come here and have those frank discussions and find support.”
On her first day as the Parish Nurse for United Methodist Church of Sturgeon Bay, Carol Moellenberndt received a call requesting a Parkinson’s Support group. That was seven years ago. Now, 12 to 24 people regularly gather for the group each month.
”It is important for people with Parkinson’s disease to connect with other people who have the disease because it is pretty isolating. At the support group, they can talk about things happening to them and they are not alone in it,” Moellenberndt said.
Not everyone with Parkinson’s disease is able to manage the exercise class. Physical therapists at MDCMCRS access interested participants and may recommend a period of physical therapy, like in Barta’s case, to get started.
“This class is letting people see they can face it stronger and make things easier for longer,” Miller said. “We are not going to cure their Parkinson’s, but we can help them live with it better and manage it better and live independently longer.”
The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. This is especially helpful for Parkinson’s patients. The Tutor system consists of ergonomic wearable devices and dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.
The new medical devices, which are effective rehabilitation tools for Brain/Spinal cord injuries, stroke, CP, MS, arm, hand, leg and hip surgeries, are available through the use of telerehabilitation and are FDA and CE certified. See www.HandTutor.com for more information.

Wounded Warrior and Tutor System–a winning Team

In an article published October 08, 2011 for FoxNews.com at San Diego, CA – On Thursday, The United States Marine Corp celebrated the grand opening of the long-anticipated Warrior Hope and Care Center at Camp Pendleton in California, Fox 5 San Diego reports.
“Recently, we returned from Afghanistan. I had 15 Marines and sailors killed and over 130 wounded and I think of each one of those Marines and what this facility will do for them,” Lt. Col. James Fullwood said.”My words cannot sum up what this facility is.”
The specialized care facility specifically designed to help wounded Marines, took two years to build and cost nearly $30 million.
The new 30,000 square foot facility will provide not only physical rehabilitation for the Marine and his or her family, but also emotional support and recreational services.
These include: a full rock wall, Olympic style track, amphitheater, state of the art gym equipment and an underwater treadmill, which officials say is one of only a few that exist on the entire west coast.
The facility couldn’t have come soon enough for Marines like Gunnery Sgt. Paul McQuigg, who was hit by a roadside bomb. Until Thursday, McQuigg had to mostly depend on going to a series of different facilities for care and at times even had to rehab independently.
“My vehicle was hit by an improvised explosive device,” McQuigg said. “In the past, every individual unit was doing the best they could to take care of their wounded or injured.”
“When a Marine is injured, it doesn’t just affect that Marine, it affects the entire family as a whole,” McQuigg said.
“It gives the service member and their families hope in seeing a light at the end of the tunnel and they are given the means to get to that light,” said McQuigg.
The Tutor system is an integral part of any worthy physical rehabilitation program. The Tutors are effective for patients suffering from stoke, head and spinal cord injuries, Parkinson’s disease, CP, MS, Radial and Ulnar nerve injuries, development co-ordination disorders, Brachial Plexus injury, post hand/arm/leg/hip surgeries, Complex Regional Pain Syndrome and other disabilities.
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. Intensive active exercise can reduce the rate of deterioration and this is what the ‘‘Tutor” devices provide.
The Tutor 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. See www.HandTutor.com for more information.