Drs. M.McCall, S.McEwen, A.Colantonio, D.Streiner etal of the Graduate Department of Rehabilitation Sciences, University of Toronto, Ontario, Canada report on a growing body of research, including evidence from numerous randomized controlled trials, suggesting that constraint-induced movement therapy (CIMT) reduces impairment. The mean age of participants in most studies has been < 65 yr, even though most stroke survivors are older than that. We investigated the efficacy of a modified CIMT protocol on participation, activity, and impairment in a population of older adults experiencing subacute stroke. Using an interrupted time series design, 4 older adults (mean age = 82) were assessed before and after intervention. Although none of the participants adhered to the 6-hr per day self-practice aspect of the CIMT protocol, considerable improvements were noted in participation, as measured using the Canadian Occupational Performance Measure. Some improvements were also noted at the level of impairment and activity. This work accords with previous literature on CIMT and has important implications for the evolution of stroke rehabilitation in elderly people.
Enter--the Tutor system. Constraint induced movement therapy (CIMT) is also a unique treatment approach used for rehabilitation of the upper limb (arm/hand) following neurological damage. After a neurological event such as a stroke it is common for people to develop a tendency not to use their weaker arm which can lead to learned non-use or in some cases neglect of the weaker arm. CIMT aims to increase the amount of use and quality of movement of the weaker arm by following a structured treatment program developed by researchers in the USA.
The treatment program works by producing ‘rewiring’ of the brain; this means that a larger part of the brain becomes active when producing movement of the weaker arm. This program is underpinned by several research studies which have proven benefits, particularly for stroke patients.
The program involves a number of components in particular the use of repetitive task-oriented training. This involves the person practicing a series of short tasks with the weaker arm for several hours a day over a two to three week period under supervision by a trained therapist. Whilst using the weaker arm the unaffected side is restrained, for example by wearing a mitt or glove to continually remind the person to use the weaker arm.
The person is encouraged to use the weaker arm outside of the treatment program for functional tasks at home whilst wearing the glove or mitt and is provided with a series of home assignments to complete. Research has proven that such intensive and repetitive use of the weaker arm over this short period leads to increased use of the weaker arm as well as improved quality of movement. Intensive exercise practice is also where the HandTutor and ArmTutor play an integral part of rehabilitation therapy.
The Tutor system consists of ergonomic wearable devices including the HandTutor for finger and wrist exercise and the ArmTutor for elbow and shoulder exercise. The Tutor system uses 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.
The Tutor system (including the LegTutor and 3DTutor for lower limb/ extremity exercise practice). Patients do intensive exercise practice using motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. The system is part of the therapy program for CP, MS, stroke, Parkinson's disease, Radial and Ulnar nerve, brain and spinal cord injury patients. Controlled exercise practice will help to prevent the development of compensatory movement patterns and assists in Constraint Induced movement therapy. 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 HandTutor, ArmTutor, LegTutor and 3DTutor are FDA and CE certified and is designed for children as well as adults.
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