Is Telerehabilitation Effective?

To determine the usefulness of telerehabilitation David Hailey etal of the School of Information Systems and Technology, University of Wollongong, Australia reviewed the evidence on the effectiveness of various telerehabilitation (TR) applications. The survey included reports on rehabilitation for any disability, except drug or alcohol addiction or mental health conditions. Considered were all kinds of telecommunications technology for TR. Both study performance and study design were considered . The results were judged on whether each TR application had been successful, whether the results were clinically significant, and whether it was necessary to gather further data to establish whether the application was suitable for routine use. There were 61 scientifically credible studies that reported patient outcomes. Administrative changes were identified through computerized literature searches on 5 databases. Twelve clinical categories were included in the studies. The ones dealing with neurological or cardiac rehabilitation were in the majority. Thirty-one of the studies (51%) were of good or high quality. The study results showed that 71% of the TR applications were successful, 18% were unsuccessful and 11% were unclear as to their status. The outcomes for 51% of the applications seemed to be clinically significant. The poorer-quality studies tended to have outcomes that were worse than those from high- or good-quality studies. The surveyors judged that further study was required for 62% of the TR applications and preferable for 23%. Their conclusion was that TR shows promise in many fields, but evidence of benefit and impact on routine rehabilitation programs is still somewhat limited. There is still a need for more detailed, better-quality studies and for studies on the use of TR in general routine care. One of the areas of success in telerehabilitation is in the use of the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are designed to give intensive rehabilitation exercises to those that have had a spinal cord/brain injury, stroke, Parkinson’s disease, MS, CP, Radial and Ulnar nerve injuries as well as other upper and lower limb surgeries or injuries. The TUTOR system uses sophisticated software that provides a customized exercise program for the individual patient. Many times the patient lives too far from a rehabilitation clinic or has improved to the point where he no longer needs to be seen in a regular clinic. In those cases the TUTORs have an excellent rehabilitation system in place for the therapist to instruct the patient remotely. Currently in use in leading U.S. and European hospitals the TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for further information.

Decisions, Decisions, Decisions

All the time we read about a famous athlete that sustains an injury and has to undergo surgery as a result of an injury or overuse of an arm , hand or leg. There is always a lingering doubt if that surgery will suspend or cancel the athlete’s playing season or even career. Michelle G. Carlson, MD writes that when a hand surgeon, for example, treats a talented athlete, many questions come up. After the physician makes a diagnosis and decides on a treatment plan, that is often a challenge to any patient but here the questions first begin. When do you treat the patient? Is it possible for the athlete to return to play with that particular injury? Should the treatment wait until the season is concluded? If the decision is to treat immediately, how long a period of time will the athlete be out of play? Is this decision going to end the athlete’s season? or his career? Will being out for the season end his career? How do these questions affect the doctor’s decision? Physicians are expected to make choices where lost days of play can make tremendous differences in the career of collegiate, professional, or even high school athletes. This is why the decisions made should include involving the most sophisticated and advanced methods of treatment so that the athlete has the best chance of returning as fast as possible to his profession. Since most, if not all, limb surgeries necessitate a period of physical therapy during recovery it is imperative for the medical professional to seek out the best physical therapy solution available. Currently that would be the recently created TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are innovative physical therapy products that are speeding the improvement of limb repair in athletes and others who have undergone hand, arm, elbow, shoulder or leg surgery. The TUTORs are comfortable ergonomically designed gloves or braces which are strategically placed on the affected limb and with special sensors connected to dedicated software that detect motion. They provide an intensive exercise program through the use of special games geared to that particular patient . The physical or occupational therapist records and evaluates the patient’s performance and creates a customized program for that patient. In addition the TUTOR system aims to optimize the motor, sensory and cognitive performance of the user. Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE and can be used at the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Recovering From Spinal Cord Injuries

It is very common that spinal cord injury patients will have feelings of fright, confusion or anxiety .They may also have feelings of disbelief because they are still alive even though they have severe disabilities. Actually rehabilitation consists of a multi pronged approach. It includes physical therapies, activities to rebuild skills and emotional and social support. The rehab team of specialists will normally include a physiatrist, recreational therapist, social worker, physical and occupational therapists, nutritionists, nurses, psychologists, case workers to coordinate everything and others. The first part of rehabilitation will consist of the physical aspect of getting the affected mobility returned. This may be accomplished only with the help of devices such as: wheelchairs, braces and walkers. To get the patient to communicate he will use normal typing, writing and phone devices. Muscle strengthening is part of actual physical therapy whereas redeveloping fine motor skills is within the role of an occupational therapist. Basic toileting routines and self grooming are also taught at this stage. If the patient shows the ability to cope, a vocational counselor (VC) will assess skills, dexterity, physical and cognitive capabilities to determine what might be available in terms of employment. The VC will also arrange for any assistive devices that may be needed in the workplace. If the patient will not be able to achieve gainful employment then the VC will find other places for the patient to spend his time in a productive manner. This could include hobbies, educational classes, getting involved in special interest groups, and participating in family and community events. Finally there is recreational therapy which would get the patient to use their abilities to participate in athletic activities at their level. This latter aspect can help to achieve a more normal lifestyle and allow for some raised self esteem. When deciding on the most appropriate form of physical therapy an effort should be made to utilize the most advanced form of physical therapy products. Such devices are now found in the form of the recently developed TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR these devices are at the forefront of assisting spinal cord injury patients to recover lost movement ability skills. The TUTORs implement an impairment based rehabilitation program with augmented feedback and encourage motor learning. The system allows the therapist to evaluate and objectively quantify and record the patient’s motor and cognitive impairments and then customizes a treatment session for that patient. Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE. They are usable by children as young as 5 as well as adults and can be used in the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Superman Foundation Supports Rehabilitation for SCI Patients

The Christopher and Dana Reeve Foundation (The actor who played Superman and his wife and who suffered from a severe spinal cord injury as a result of falling from a horse) has provided support through its national network of activity-based rehabilitation centers for spinal cord injury for treatments in conjunction with research conducted by the University of Louisville, Kentucky. It was announced on Sept. 5, 2012 that research studies from teams headed by a University of Louisville/Frazier Rehab Institute neuroscientist that innovative rehabilitation treatments for patients with spinal cord injuries (SCI) can lead to significant functional improvements and a higher quality of life. Studies published in the September issue of “Archives of Physical Medicine and Rehabilitation” show that creating a network of rehab centers for SCI that standardizes treatment can bring significant functional improvements for chronically injured patients. Another study published in the September issue of ”Journal of Neurological Physical Therapy” showed that expenses associated with home renovations, equipment, and transportation actually decreased by almost 25 percent for patients with motor incomplete SCI due to the function gained following intensive locomotor training intervention. The findings suggest that a shift in both protocol and policy is necessary to standardize rehabilitation across multiple centers. The Neuro Rehabilitation Network (NRN) was established by the Reeves Foundation and is funded by the U.S. Centers for Disease Control and Prevention (CDC). Locomotor training is an intensive, activity-based intervention therapy that attempts to re-train the nervous system by simulating stepping and walking for those with spinal cord injuries. “These results support the concept that there exists an intrinsic capacity of the human spinal cord circuitry that responds to task-specific sensory cues that can result in recovery in walking,” said NRN director Harkema. Understanding the capacity for recovery and standardizing locomotor protocols are very important in finding out what the outcomes of future studies will be for SCI patients. Even if the patient has been injured for a length of time locomotor training is beneficial. There is now evidence that standardized rehabilitation can result in positive patient recovery according to the vice president of research of the Reeves Foundation, Susan Howley. She adds that the studies show that rehabilitation is definately part of the repair process. Locomotor training is used for people not only with brain and spinal cord injury but also stroke and other neurological disorders. Many SCI patients using locomotor training in German, Canadian, Swiss and American clinics have improved their ability to walk. Locomotor training consists of A- step training using body weight support on a treadmill (BWST) and manual assistance; B-over-ground walking training; and C-community ambulation training. Information from the legs and trunk while walking is constantly sent to the spinal cord using BWST. The therapist makes sure that the patient is optimizing standing and walking. As the patient improves, the assistance of the therapist is reduced. In line with the rehabilitation protocol mentioned above for SCI patients it should be noted that the most effective physical therapy solutions will be those that allow for an intensive exercise program. Such products can be found in the TUTOR system. The TUTORs have shown much success in rehabilitation of joint movement. The recently developed TUTORs consist of ergonomic wearable devices. The HANDTUTOR is a glove for hand therapy and the ARMTUTOR is an arm brace for elbow and shoulder rehabilitation. The LEGTUTOR is a leg brace for leg and hip. The system is indicated for patients who have suffered TBI, a stroke, SCI, CP, MS, Parkinson’s disease and other mobility restraining illnesses. It is used by occupational therapists and physiotherapists in rehabilitation centers, private clinics and in 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 accompanying software system consists of motivating and challenging games that encourage the patient to practice isolated and/or interjoint coordination exercises. The dedicated rehabilitation software allows the physical and occupational therapist to fully customize the exercises to the patient’s movement ability. In addition, the OT and PT can make objective reports on their patient’s progress. Rehabilitation aims to optimize 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 TUTORS are certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

Hip & Knee Surgeries–How to Avoid Them

By now the public knows a lot about and utilizes hip and knee surgery to get a new ”lease on life” when the old joints need replacement. In an article authored by Brent Steepe, a training specialist, on September 5, 2012 he discusses ways to totally avoid the drastic operations and their painful ramifications. Sometimes people who have had those surgeries come to him as the results were not what they were supposed to be or that they are are still in pain. The ”trick” is to determine whether the problem is skeletal or muscular. For this one needs a qualified professional. If the problem is muscular then surgery probably won’t help at all. Having surgery in those cases by inserting metal rods and getting fusions can even cause more pain and other problems. Steepe explains that the problem can be the fact that the rod is inflexible and that it will only force other muscular systems to adapt. Many times a knee replacement is followed by a hip replacement because of that phenomenon. Steepe tells about a woman whose knee joints had become ”bone on bone” and wanted knee surgery. Medications and injections were not helping. Knee replacement was prescribed. She wanted very much to walk and climb stairs pain free. Work was commenced to realign and retrain the muscles on her body so that they would work as designed. After a year and a half she has no pain and can even run. In order to embark on this course of correction the trainer needs to understand the lifestyle of the patient and determine what activities caused the problem in the fist place. Also was the original injury given the proper treatment and attention. Most of the time it turns out that the body part was overused or misused. The next step is to determine where muscle rebuilding needs to take place, what movement patterns need to be changed and what muscles need more support. In that way a plan can be made to alter movements of muscles so that joints can be used in a way that they were intended to move. Then those ”new” positions are reinforced and over time the problem is resolved. The severity of the injury will determine the length of time it will take to solve the problem. Minor problems can be corrected in a short period of time while if a major core muscle group was affected it will take longer. Steepe emphasizes that some previous activities may have to be curtailed or stopped altogether so that the problem doesn’t reoccur. Sometimes all that is needed is to use different muscles and movement patterns. When these non surgical methods are not sufficient and radical surgery is nevertheless needed then during the rehabilitation phase of recovery the patient should avail himself of the most efficient physical therapy solution available. The current trend is to use the TUTOR system of physical therapy products. The LEGTUTOR would be the key component for physical rehabilitation following knee or hip surgery. The LEGTUTOR is an ergonomic wearable leg brace with dedicated rehabilitation software. 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. This means that the LEGTUTOR system allows the physical therapist to prescribe a leg rehabilitation program customized to the patient’s knee and hip movement ability at their stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice with those that were designed in the form of challenging games. They are suitable for a wide variety of other neurological and orthopedic injuries and diseases as well as post trauma and orthopedic surgery. The LEGTUTOR is also used by physical and occupational therapists in combination with the HANDTUTOR, ARMTUTOR and 3DTUTOR for upper and lower extremity rehabilitation. The TUTOR system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home supported by telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Physical Rehabilitation Through Sports Activities

A division of the U.S. Olympic Committee, the U.S. Paralympics, was formed to become a world leader in the Paralympic sports movement and to promote excellence in those people with physical disabilities. Formed in 2001, U.S. Paralympics has been helping Americans achieve their dreams. U.S. Paralympics is making a difference in the lives of thousands of people with physical and visual disabilities daily through education, sports programs and connections with community organizations, government agencies and medical facilities. There are an estimated 21 million Americans with a physical disability. In recent years, thousands of military personnel have sustained serious injuries during their tour of active duty. Research has shown that daily physical activity improves not only the individual’s self-esteem and peer relationships, it also results in a higher quality of life, increased achievement and better overall health. However most individuals with physical disabilities do not have the opportunity to participate in regular sports activity., That’s why U.S. Paralympics is working hard to make this an important national issue. There are 3 ways in which U.S. Paralympics operates programs. 1) Community Programs. U.S. Paralympics manages many outreach initiatives, that connect with individuals who have physical disabilities directly and supporting Paralympic organizations with program development. A key goal of the U.S. Olympic Committee is to increase the availability of Paralympic sport programming across the country. By partnering with existing organizations, as well as the development of new programs, the U.S. Olympic Committee’s Paralympic Division is targeting 250 Paralympic Sport Clubs in American cities by this year of 2012. USOC Paralympic Military Program. 2) The Paralympic movement was founded through a rehabilitation program developed for World War II veterans that were wounded. In addition, the Paralympic Military Program provides rehabilitation support and mentoring to American veterans who sustained physical injuries. Veterans are introduced to Paralympic opportunities and sport techniques through various clinics and camps. They are also connected with ongoing Paralympic sports programs in their hometowns. The program is not just about sports; it is also about attitude, comaraderie and promoting healthy, active lifestyles. 3) Elite Athlete & Team Support. U.S. Paralympics has been a leader in the preparation and selection of national Paralympic teams for 24 different sports. The athletes represent the U.S. in the Paralympic Games and other international competitions. Another impressive organization that combines the disabled with sport is Israel’s TIKVOT. Tikvot is a non profit volunteer based organization which rehabilitates Israel’s victims of terror through sport. Tikvot means “Hopes” in Hebrew and it has been proven that sport, Tikvot’s tool, provides these heroes with Hope, giving them the power to restore self confidence and dignity. Tikvot operates in tandem with the world’s top specialist organizations with specific expertise in the design of unique sports rehabilitation programs suited expressly to each disability. TIKVOT – brings along the guidance, support and funding for these projects, beginning with the onset of injury and the subsequent period of hospitalization to ultimate rehabilitation on the sports field. When rehabilitation is required for sports or disease related injuries the affected patient should have access to the best physical therapy products available. Such devices can be found in the TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR, The TUTORs have become a key system in neuromuscular rehabilitation for stroke victims and those recovering from sports injuries, brain and spinal injuries, Parkinson’s, MS, CP and other limb movement limitations. The TUTOR products implement an impairment based program with augmented motion feedback that encourages motor learning through intensive active exercises and movement practice. They consist of ergonomically designed wearable glove and braces that detect limb movement showing the patient how much active or assisted active movement they are actually doing. The rehabilitation software uses specially designed games to set a new target for this movement in terms of the patient’s ability to move their affected limb. The devices then measure the limb movement and give feedback on the success of the patient in trying to gain this new movement objective. In this way the patient understands which effort is more successful in allowing them to move their affected limb again. The TUTOR system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice. The TUTORs are now part of the rehabilitation program of leading U.S. German, Italian, French, UK and other foreign hospitals. They are available for children from the age of 5 and at home throughthe use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Rehabilitation as a Way to Improve Quality of Life

A journal article authored by R.T. Abresch etal of the Department of Physical Medicine and Rehabilitation, University of California, Davis, . USA discusses how improving quality of life has been a goal of rehabilitation medicine. However, the problem lies in that health care providers often do not know much about the quality of life of individuals that have neuromuscular diseases (NMD), nor what factors will help them to achieve a good quality of life. This lack of knowledge about subjective quality of life factors can bring negatively influenced expectations and the selection of treatments. In the most obvious cases, a physician’s subjective but incorrect assessment of a disabled individual’s quality of life may prevent the patient from receiving life-sustaining interventions. As a group, the quality of life of individuals with NMD is not much different than nondisabled controls and is substantially better than presumed by the general public and, often times, by health care workers. Nevertheless, sometimes their quality of life is reduced in certain areas. Level of disability is not a critical factor that significantly alters life satisfaction, surprisingly. Presumably, this is because physical functioning has been adequately managed. The greatest problems that individuals with neuromuscular disease identified were: lack of information about the disease and services; poor coordination of services; a diminished expectation of their potential and negative attitudes. In addition, people with severe disabilities had significant problems financing, obtaining, and managing personal care attendants. Factors related to a good quality of life were, on the other hand, related to perceived control, perceived health status, but not disability. The more that people could do for themselves, either on their own or with personal care assistants, use of technology, assisstive devices, the better their quality of life. One of the most comprehensive systems to achieve success in rehabilitative medicine is through the use of the TUTOR physical therapy products the results of which will achieve an improved quality of life. Nowadays physical and occupational therapists as well as other health care providers are getting to know that the TUTORs can change not only perceptions but actual outcomes of disability related attitudes. The TUTORs, conisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR, have been created to allow the patient to conduct intensive exercises in a fun way and to derive satisfaction from his successes. Physical therapists monitor the exercises and design a custom made program for that patient. This allows the patient to derive a sense of accomplishment that he himself (and not a robot) has produced and will hopefully lead him to a higher level of independence by performing everyday tasks In addition the TUTORs improve fine motor, sensory and cognitive impairments. The physical therapy products in the form of the TUTORs are ergonomically designed gloves and braces that contain sensors connected to sophisticated software. This software gives the therapist objective and quantitative information on the patient’s functional impairment. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are the preferred physical therapy solution for rehabilitation for patient’s who have suffered a stroke, brain or spinal cord injury, Parkinson’s disease, CP, MS and other upper or lower limb surgeries. Currently the TUTORs are being used in leading U.S. and European hospitals and clinics. They are fully certified by the FDA and CE and are available for children as young as 5 and at the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Exercising for the Heart

Cardiovascular disease around the world is one of great concerns to patients and health providers alike. Cardiac rehabilitation aims to return patients with heart disease to health by exercise-only based rehabilitation or comprehensive cardiac rehabilitation. The Objective of a study on the subject was to determine the effectiveness of exercise-only or exercise as part of a comprehensive cardiac rehabilitation programme on the mortality, morbidity, modifiable cardiac risk factors and health-related quality of life (HRQoL) of patients with coronary heart disease. Electronic databases were searched for randomized trials, using standardised trial filters, for a period of about 10 years. The subject of the trial were men and women of all ages, whether in hospital or in community settings, who had coronary artery bypass graft, myocardial infarction, or percutaneous coronary angioplasty, or who had angina pectoris or coronary artery disease. The studies were selected independently by two reviewers, and data was collected independently. 8440 patient results were analyzed. The results showed that exercise-based cardiac rehabilitation is effective in reducing cardiac deaths. It is not clear from this review whether exercise-only or a comprehensive cardiac rehabilitation intervention is more beneficial. More research will have to be done to determine that.The population studied in this review was still predominantly low risk, male and middle aged. Identification of the ethnic origin of the participants was seldom reported. (It is possible that patients who would have benefited most from the intervention were not included in the trials on the grounds of age, sex or co-morbidity). In plain lamguage it was found that regular exercise or, alternatively, exercise with education and psychological support can lower the likelihood of dying from heart disease. Coronary heart disease (CHD) is one of the most common forms of heart disease. The heart is affected by restricting or blocking the flow of blood around it. This in turn can lead to a feeling of tightness in the chest (angina) or a heart attack. Cardiac rehabilitation tries to restore people with CHD to health through regular exercise or a combination of exercise together with education and psychological support. The findings of this review show that either form of cardiac rehabilitation can reduce the likelihood of death from heart disease. One of the current tested methods of exercise is the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been devised to offer the patient intensive exercises for a variety of ailments. The TUTOR physical therapy products are ergonomically designed gloves and braces that include sensors connected to exclusive, motivating and challenging games. This allows the patient to practice isolated and/or interjoint coordination exercises. The physical therapist then records and evaluates these movements and designs an exclusive exercise program for the patient. The TUTORs are currently in use in leading U.S. and European rehabilitation hospitals and clinics and are also available for home use through telerehabilitation. The TUTORs are usable by adults and children and are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for further information.

U.S. Army Enters Fight …Against Traumatic Brain Injury

It was reported by the Army News Service on August 31, 2012 that the U.S. Army together with the National Football League will be joining to increase the research into the causes, prevention and treatment of Traumatic Brain Injury (TBI). An agreement was reached and signed by Army Chief of Staff Gen. Ray Odierno and NFL Commissioner Roger Goodell to continue sharing their resources to combat TBI. Attending the event were soldiers and players who have had concussions during their service or games. Representatives of the medical corps and 200 cadets also participated. Ironically it is the tough discipline and feeling of team over self that they are taught which prevents soldiers and players from disclosing that they were injured and from seeking help after a concussion. These traits make it difficult for individuals to admit that they have a particular problem, especially mental. Gen. Odierno stated that the goal of the new program is to educate the soldier and player to come forward and be educated that they have to seek treatment both on the battlefield and on the playing field. The general discussed various examples of how dialogue and the sharing of research can monitor TBI. One of the methods is placing sensors in the helmets that are worn that can detect a concussion after a trauma to the head occurs. NFL commissioner Goodell told those assembled that basic cultures (of not disclosing concussions) have to change making players and soldiers share their experiences. The importance of disclosing the incident with officers higher in rank needs to take place without fear of retribution just because they disclosed what happened. Some officers and players told about their personal experiences and how they were reluctant to seek help. The NFL commissioner stated that not asking for help will no longer be tolerated. That there has to be accountability. That coaches and other players will no longer be able to make the decision. Only medical personnell will be allowed to judge whether a player or soldier can return to duty. Proper leadership and supervision includes allowing this to happen. ” Seeking help is playing smart.” he added. Both officials said that enough progress hasn’t been made yet and more needs to be done. There is an Army Directive that stipulates that soldiers have a minimum of 24 hours of downtime and need to get a medical clearance before returning to duty following a blast or vehicle incident. Maj. Sarah Goldman, program director of Army Traumatic Brain Injury at the Office of the Surgeon General, Rehabilitation and Reintegration Division, stated that more than 13,000 service members sustained some form of concussion since 2010 and 95 percent were returned to duty. Odierno, admitted that when he played football he would not have sought medical attention for a concussion. “I wouldn’t have taken myself out. Someone else would have had to.” He said that kind of thinking is wrong. The general added that the army and players have to have a bond to take care of each other no matter what the rank. When TBI occurs the best physical therapy solutions should be put in place. Currently that includes the TUTOR system. Victims of brain injury and stroke can benefit greatly from the Tutor system– the HANDTUTOR, ARMTUTOR, LEGTUTOR and the 3DTUTOR. The Tutor system is being used successfully in leading U.S. and foreign hospitals and clinics and is also benefiting home care patients through the use of telerehabilitation.This ensures that the patient is motivated to do more practice between treatments by the therapists. The newly developed HANDTUTOR and its sister devices have become a key system in neuromuscular rehabilitation and physical therapy for brain injury patients including, post stroke and TBI patients. These innovative physical therapy products implement an impairment based program with augmented feedback that encourages intensive practice and motor learning through active exercises. The exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance , motor , sensory and cognitive movement ability. Customized simple and powerful rehabilitation software allows the physical and occupational therapist the ability to adjust the program and exercise difficulty to the patient’s movement ability. The system also includes objective quantitative evaluations that allow the physiotherapist and his occupational therapist colleagues to report on the patient’s exercise progress. The TUTOR system is suitable for children as well as adults. See WWW.MEDITOUCH.CO.IL for further information.