Tutor System Developed for Children Recovering From TBI

Dec 16 2011
Treating kids with traumatic brain injuries
According to the Centers for Disease Control and Prevention, 50,000 people in the U.S die each year from TBI and 85,000 people suffer long term disabilities. In the U.S more than 5.3 million people live with disabilities caused by TBI. There are many different kinds of treatment for TBI patients such as: the initial treatment that stabilizes an individual immediately following a traumatic brain injury; Rehabilitative Care Center Treatment to help restore patient to daily life; Acute Treatment of Traumatic Brain Injury is aimed a minimizing secondary injury and life support; and surgical treatment that may be used to prevent secondary injury by helping to maintain blood flow and oxygen to the brain and minimize swelling and pressure.
There are many causes of TBI. The top three are car accident, firearms and falls. Young adults and the elderly are the groups at higher risks of TBI. The mechanisms that are the highest cause of brain injury are: open head injury, closed head injury, deceleration injuries, chemical/toxic, hypoxia, tumors, infections and stroke. An open head injury results from something such as a bullet wound in which there is penetration of the skull. A closed head injury results from something such as a slip and fall or motor vehicle accident where the effects tend to be broad. Deceleration occurs when the brain is slammed back and forth in the skull because of its gelatinous consistency; causing even the nerve cells to stretch and compress where if it stretches enough the nerve cells can tear. Certain chemicals and toxins can also damage neurons, such as insecticides, lead poisoning and solvents. Hypoxia is lack of oxygen and can be caused by respiratory failure, heart attacks, drops in blood pressure; this can cause severe cognitive and memory deficits. (www.traumaticbraininjury.com)
TBI is classified into two categories: mild and severe. A brain injury can be classified as mild if loss of consciousness and/or confusion and disorientation is shorter than 30 minutes. While MRI and CAT scans are normal the individual has cognitive problems such as headache, difficulty thinking, memory problems, attention deficits, mood swings and frustration.
Severe brain injury is associated with loss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury longer than 24 hours. The deficits range from impairment of higher level cognitive functions to comatose states. Survivors may have limited function of arms or legs, abnormal speech or language, loss of thinking ability or emotional problems. The range of injuries and degree of recovery is very variable and varies on an individual basis.
Dr. Jose Pineda, Pediatrician, Director of Neurocritical Care, St. Louis Children’s Hospital, Washington University, talks about a new approach to teach kids with traumatic brain injury.
Dr. Pineda says that traumatic brain injury is the number one cause of death and disability in children. Every day it kills more children than cancer or any other disease. As a matter of fact TBI kills more children than all other top ten diseases put together. So it’s a real problem. Not only is it very common, but also the brain is very complex. We don’t even understand how it functions fully. So when it’s injured it’s very difficult to treat it. We have made a lot of progress in the past few years but we have a lot of challenges.
Dr. Pineda says additionally that we are very excited we started this quest about five years ago. I was recruited to St. Louis to tackle this new challenge and say okay, every kid is doing better with heart disease, with cancer and all that — let’s do something about brain injury. I took on that quest, and we have observed over the past five years a seventy percent decrease in mortality in children with severe traumatic brain injury. We also observed an improvement in outcome on those children who survived. And that’s very important with brain injury. The fear always is you do something that decreases the number of children who die but increases the number of children who survive in bad shape. The good news is as it has happened in the past with previous leaps in improving recovery children go from, “I was going to die” to “I do great.” They skip the middle and that is exactly what we have seen. So we have seen a seventy percent decrease in mortality matched to an improvement in the outcome of survivors. To give you an idea, and this is scientific, it will take us time to explain it in a way that we can demonstrate scientifically what we are saying. It’s important to be able to say, for example, that since 2008 every child with severe traumatic brain injury treated here has gone home except for one child. And it didn’t used to be like that many of them had to go to extended care facilities, and that’s disappearing too. So in summary, yes, we have seen a seventy percent decrease in mortality with children with severe traumatic brain injury in the past five years with the implementation of the neurocritical care program here at St. Louis Children’s Hospital. And not only that, that seventy percent decrease in mortality is linked to improvement in function in those children who survived. The vast majority of them are now going home.
The HandTutor, ArmTutor, Leg Tutor and 3d Tutor have been developed to teach children how to reuse their joints after a brain or spinal cord injury. The unique and successful devices use a dedicated software that utilizes games to enhance and improve their movement.
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, both children and adults, in rehabilitation centers, private clinics and the home where it can be supported by telerehabilitation. It is designed for those who have head, trunk, upper and lower extremity movement dysfunction.
The system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. Controlled exercise practice will help to prevent the development of compensatory movement patterns. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. In addition the therapist can objectively and quantitatively evaluate and report on the treatment progress. The rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows the patient to better perform everyday functional tasks to improve their quality of life. The Tutor system is FDA and CE certified. See www.HandTutor.com for more information.