Complimentary Medicine and Physical Disabilities

A U.S. national survey researching the connection between the use of complimentary medicine and those that have a physical disability produced some interesting results. Matthew J. Carlson, Ph.D. and Gloria Krahn of Portland State University and Oregon Health & Science University conducted the survey, the purpose of which was to estimate the prevalence of complementary and alternative medicine (CAM) as used by the practitioner, assess the reasons for its use, and determine the symptoms for which CAM practitioners were consulted. This was conducted in a national US sample of insured adults with physical disabilities. The methods used were data from a longitudinal survey on a national sample of some 830 adults covered by health insurance who had one of the four disabling conditions: cerebral palsy, multiple sclerosis, arthritis and spinal cord injury. Cross sectional analysis of the data produced estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted. The results showed that CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. The use of CAM was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%). It was used by former devotees (62%) compared to non-users (8%). Spinal cord injury reported the lowest use (14%). The most common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). The common reasons for using CAM practitioners included a lifestyle choice (67%) and also because they are perceived to be more effective than conventional medicine (44%). The conclusions of the survey suggest that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning. Effective treatment of physical disability can also be achieved by obtaining and using the correct physical therapy product. Leading the pack is the TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR these recent innovations have been created to treat physical limb disabilities as a result of a stroke, brain or spinal cord injury, Parkinson’s disease, MS, CP and other upper or lower limb disabilities. The TUTOR system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. Consisting of ergonomicaly designed gloves and braces the TUTORs optimize the patient’s motor, sensory and cognitive performance and allows him to better perform daily functional tasks and thereby improve his quality of life. The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are available at home through telerehabilitation. Fully certified by the FDA and CE the TUTORs can be used by adults as well as children from the age of 5 and up. See WWW.MEDITOUCH.CO.IL for further information.

Ski Accident Statistics and Their Physical Therapy Treatment

Skiing is one of the world’s favorite sports and as such there are a fair amount of injuries to skiers. An analysis of injury statistics compiled over 12 seasons, encompassing 2.55 million skier-days, at a ski resort in Wyoming was used for a ski accident survey. Ticket sales per year was the method of calculating the population surveyed. 9749 skiing injuries were indexed by region and severity according to diagnosis on the initial evaluation. The rates of injury were then analyzed as a function of time. During the 12 seasons the injury rate remained constant at 3.7 injuries per 1000 skier-days. During the study period the rate of lower extremity to upper extremity injury decreased from 4:1 to 2:1 . The ankle injury rate also decreased with time. 7% of all injuries were Ulnar collateral ligament sprains. 30% of all injuries were knee sprains. Anterior cruciate ligament tears increased as a function of time and accounted for 16% of all skiing injuries during the same study period. The most common injury was the medial collateral ligament sprain at 18% of all skiing injuries. In addition there were also forty-seven snowboard injuries recorded. All of the above injuries can be treated by physical therapy products known as the TUTOR system once the patient has been stabilized and is ready for rehabilitation. The TUTORs provide intensive exercise for all upper and lower limb injuries or surgeries. They are also effective for patients who have Parkinson’s disease, stroke, CP, MS, head and spinal cord injuries and other debilitating medical issues. The TUTOR system consists of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. These products include 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 fully certified by the FDA and CE and is currently in use by leading U.S. and European hospitals and clinics. The suystem is available for children from the age of 5 and up and in the home through telerehabilitation.

Children’s Upper Limb Function and Constraint Induced Movement Therapy

Is there a connection between Constraint-Induced Movement Therapy (CIMT) and the resulting improved upper limb function for children with hemiplegic Cerebral Palsy? A study by Sheri Montgomery, OTR/L, FAOTA University of Utah OTD dated October 2012 discusses this theory. Children that have upper limb hemiplegia often have decreased ability to participate efficiently and effectively in tasks and occupations that require use of both hands. This may include fastening buttons while getting dressed, climbing the monkey bars or school activities such as opening a gym locker or completing a standardized academic assessment such as during play using a keyboard. Amongst the traditional strategies used by OTs for the treatment of upper limb hemiplegia are: fine motor skill reinforcement, strengthening of the affected limb, Electrical Muscular Stimulation (EMS) and Neurodevelopmental Treatment (NDT) techniques. In addition they have also implemented constraint-induced movement therapy programs as a type of intervention. Originally used only with adults this treatment has been used increasingly with children since 1990. CIMT was originally used in conjunction with Botox but the research wants to determine if it can be used alone. The question is can CIMT increase upper limb skills of children with hemiplegic CP to allow for age appropriate actions such as: self care and playing with other children? A review of nineteen studies was made that showed that: • Statistically and clinically significant improvement was noted in self-care and bilateral upper extremity use after two-weeks treatment with constraint-induced movement therapy for children with hemiplegic cerebral palsy. • The greatest improvement was when CIMT was paired with goal directed therapeutic intervention programs. Intensity of CIMT did not have any significant influence on the outcomes or improved motor skills. Bottom line evidence suggests that constraint-induced movement therapy results in an increased use of the affected limb, especially when matched with therapeutic interventions intended to increase strength, control and functional use. It made no difference if children wore the restraint for 3.5 hours a day or 10 hours. The greatest improvement in functional skills was observed when Constraint Induced Movement Therapy was paired with goal specific interventions. Today adult and child patients with upper limb hemiplegia can take advantage of one of the most effective physical therapy products for use in CIMT. The HANDTUTOR has been devised to provide intensive repetitive functional task exercises. The HANDTUTOR 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 HANDTUTOR improves patient functional upper extremity movement ability in severe and moderate movement dysfunction. The HANDTUTOR intensively trains simple movement parameters using isolated exercise practice. The tasks can be set according to the individual patient’s limits of movement ability and the difficulty of the tasks can be shaped. The feedback gives the patient information on his performance of the tasks and instructions on how to improve his movement. The HANDTUTOR and its sisters (ARMTUTOR, LEGTUTOR, 3DTUTOR) have been used successfully for the treatment of Parkinson’s disease, CP, MS, brain and spinal cord injury, stroke and other upper and lower limb disabilities. Fully certified by the FDA and CE the TUTOR system is available to be used at the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Stroke Victims and Physical Therapy Gloves

It was reported on Oct. 23, 2012 that a mechanical glove has been devised to aid stroke victims by a Victoria University, New Zealand student. Abigail Arulandu has joined a field that already has physical therapy products such as the HANDTUTOR that have proven success records that achieve the same thing and have been assisting stroke patients for several years. Since most stroke victims have clenched hands as a result of the stroke the purpose of therapy is to get them to expand and reuse the hand. Ms. Arulandu’s device has sensors that measure exerted force as does the HANDTUTOR. The information gleaned is transmitted to physical therapists for analysis. The HANDTUTOR system uses exclusively designed games such as: Snowball, Car race, Bubbles, Asteroid attack and others to challenge the patient in an enjoyable way. These exercises bring the patient to a state where they will be able to function as before the stroke. Arulandu is attempting to emulate known physical therapy solutions for post stroke rehabilitation such as the HANDTUTOR and should be commended for her efforts. The HANDTUTOR is one of several similar products already on the market such as the ARMTUTOR, LEGTUTOR and 3DTUTOR that are available and currently being used in leading U.S. and European hospitals and clinics. The ARMTUTOR is the device of choice for injuries and diseases affecting arm, elbow and shoulder problems. The LEGTUTOR assists patients who have had knee or hip replacement surgery. The 3DTUTOR is a wireless motion feedback device that can be positioned on discrete joints of the head, trunk, upper or lower extremities. This allows for evaluation and treatment of the joint of choice. The 3DTUTOR can be used alone or in combination with the ARMTUTOR or LEGTUTOR to exercise additional interjoint coordination movements. The TUTOR system has also been used to rehabilitate victims of traumatic brain or spinal cord injury, Parkinson’s, CP, MS, Brachial Plexus Injuries and more. All of the TUTORs can be used at home through the use of telerehabilitation and are fully certified by the FDA and CE. Prototypes of new and similar products are fun to create but why duplicate what is effective already? More information about the TUTORs is available at WWW.MEDITOUCH.CO.IL

Alternatives to Knee Replacement Surgery

James Jacobsen, 70, knew he would need knee surgery when he saw the x-rays to explain why he was suffering so much pain. It was bone on bone now. But is knee replacement surgery really the only answer? Jacobsen was referred to an orthopedic specialist. At this point he was given information listing the pros and cons of the surgery but also alternative solutions. In this way he could make an intelligent decision about his future. “I’ve got to have my legs under me,” ”I’m not going to have a knee replaced until it’s absolutely necessary” he said. A study published in September 2012 in the journal ”Health Affairs” found that introducing alternative solutions to knee replacement surgery in Seattle led to 38 percent fewer knee replacements, 26 percent fewer hip replacements, and significantly lower costs for the health system during a period of six months. This information is especially important as it comes when there is a phenomenal rise in knee surgeries. There are many factors for this rise: an active population of baby boomers now facing osteoarthritis, growing rates of obesity and the continuing improvement of artificial joints. There has been improved communication between orthopedists and their patients recently to help bring this about. Studies by the Agency for Healthcare Research and Quality and what was published in The Journal of the American Medical Association found that the increase in knee replacement surgery has increased 2.5 times for those middle aged in a period of 10 years and that the surgery for medicare patients has increased 162 percent in 20 years. Osteoarthritis is the major contributor to this phenomenon followed by obesity. Advertisements for artificial joints has also been a factor. However, Dr. John Tierney, an osteopath and orthopedic surgeon based at New England Baptist Hospital and Greater Boston Orthopedic Center, who is one of several doctors recommending a more conservative approach said that he tries to help patients forestall the surgery step as long as possible. Some of those delaying tactics are: losing weight of bariatric surgery to treat obesity, changing lifestyles in order to avoid certain activities, strengthen muscles around the joints and taking pain medication to reduce inflammation. Sometimes there can be a benefit to wearing a brace to offset an unbalanced set of legs. Cortison injections are also an alternative treatment against the joint pain. Since no medication exists yet to counter the progression of osteoarthritis, it is important to remember that artificial joints wear out eventually so delaying the surgery as long as possible makes sense. Dr. David Arterburn, lead author of the Health Affairs study and a researcher at Group Health Research Institute in Seattle, says “…to make sure that patients understand that there is more than one option when it comes to osteoarthritis treatment.” Karen Sepucha, of the Health Decision Sciences Center at Massachusetts General Hospital, says that just because you’re ‘clinically appropriate’ for the surgery doesn’t mean you should have it. To make sure that patients who decide to go through major procedures truly want them, Mass. General now gives patients decision aids for 36 different conditions, including knee osteoarthritis. Being an educated patient is crucial to making the right decision because even physicians will not be able to guarantee success. The LEGTUTOR is a physical therapy product that has a dual function. It can be used prior to knee surgery to strengthen the muscles around the knee joint so that surgery will be more successful, less painful and allow for a more speedy recovery or in fact it may even prevent the need for surgery. Alternatively it can be used as a device to exercise the leg, knee or hip after surgery in order to speed recovery. 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 personal stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice 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, LEGTUTOR 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.

Traumatic Brain Injury and Youth Crime

A British report just published makes some surprising and alarming claims. Apparently, 60% of young people in the British justice system custody say they have experienced a traumatic brain injury. The report cites the fact that brain injury is more prevalent in the under 25 age group.This does not mean that brain injury turns those youths into criminals. The report, was written by Professor Huw Williams and commissioned by the Barrow Cadbury Trust for the Transition to Adulthood (T2A) Alliance. There is a prevalent belief in UK and US legislative authorities that once a person becomes 18 years of age he or she are mature individuals and therefore are responsible for their actions. This is at best unhelpful and at worst a tragedy of the criminal justice system. It can actually prolong the criminal behavior of an individual. There is a basic misunderstanding of age boundaries. Age limits and restrictions rarely correspond to scientific evidence. A 16-year-old isn’t any more resistant to the damaging effects of smoking than a 14-year-old. As soon as someone reaches a legally determined age, they don’t automatically mature overnight. There is no internal switch that gets flipped. ”Underage pregnancy” is somewhat of an oxymoron – if a female is physiologically capable of becoming pregnant, then she is old enough to reproduce as far as nature is concerned. But society rightly recognizes that just because someone is biologically capable of doing something, they are not necessarily mentally capable of doing it without causing damage to themselves or others. Ensuring an individual is mature enough to understand and handle the consequences of potentially damaging actions is why age restrictions exist. But this concept of “maturity” is where problems arise. The criminal justice system works under the assumption that, once an individual is 18, they are mature enough to be considered a typical adult.The argument made is that this is not the case, and that young adults should be recognized as a separate group by the criminal justice system, and their cognitive development maturity and socioeconomic factors should be considered fully when processing them, up to and including the court sentencing the individual. Scientific evidence and a literature review by Birmingham University supports this view. Studies into post-adolescent brain development reveal that brains continue to develop well into our 20s, and these developments are concerned with more complex abilities like: executive functioning and inhibition. The latter overrule our need for immediate reward, moderate our impulsive actions and regulate our emotions. That is what the majority of people would consider signs of maturity. There is another factor that has a serious impact on cognitive development and behavior of young adults and that is brain injury and trauma. Head injury is very serious . A concussion is serious, even if it does not cause lasting damage. Any injury to the head that causes even a short period of unconsciousness should be taken seriously, as it could result in a long-term injury. Because of the complexity of the brain and uncertain nature of brain injury, the eventual consequences of traumatic brain injury can vary, potentially leading to disorders such as schizophrenia. Many “criminals” are imprisoned who suffer from schizophrenia. Should they be in prison or under treatment elsewhere? In younger people brain injury is potentially more damaging, as it can potentially disrupt cognitive development. These disruptions could lead to an increased tendency for criminal behaviour. Those without a TBI [traumatic brain injury] are more likely to grow out of an immature and antisocial behavior by the time they get to the mid-twenties but those with TBI are likely to continue to grapple with these issues throughout young adulthood and beyond. There can be no generalization, however, that all youths who suffer from TBI will graduate into a criminal life. Most do not. But in young adults, brain injury increases the likelihood of eventual criminal behavior. However since there is a tendency for a relationship between criminal behavior and TBI this should be considered when making decisions about sentencing and rehabilitation. Today young people aren’t screened for brain injury and thus it is rare that there would be necessary rehabilitation. As a result, the main contact that many young people with TBI have with those that provide services is via the criminal justice system, which obviously can’t deal with and treat brain trauma. It is strongly suggested, though, somewhat impractical at this time, that young offenders should be screened for TBI and treated which would then cut the rates of a reoffense and save the taxpayer costs in the criminal justice system. Interestingly, work is already under way on some tools for determining the mental state and maturity of the offenders, such as targeted questionnaires. But ironically, this would be predicated on the fact that offenders would be honest with those responsible for prosecuting them. This would require a degree of maturity and control. The point made above is that they may lack the trait of honesty. We should be aware how damaging it can be to demand certain types of behavior from teenagers (and then punishing them based on this) without considering the physiological and cognitive changes they are undergoing. No one is suggesting that young offenders get away with their crimes but it is necessary to take into account the aspects of developmental maturity and brain injury which can affect their behavior and maybe reduce the likelihood of future crime and punishment. When Brain injury occurs and there is paresis in a particular limb the most effective physical therapy solutions should be found when the patient is sufficiently recovered. The newly developed HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) have become a key system in neuromuscular rehabilitation for patients recovering from brain and spinal injuries, Parkinson’s disease, MS, CP and other limb movement limitations. These innovative physical therapy products implement an impairment based program with augmented motion feedback that encourages motor learning through intensive active exercises and movement practice. The TUTORs consist of wearable gloves and braces that detect limb movement showing the patient how much active or assisted active movement they are actually doing. The rehabilitation software uses special games to set a new target for this movement in terms of the patient’s ability to move their 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 TUTOR system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are now part of the rehabilitation program in leading U.S. German, Italian, French, UK and other country’s hospitals and clinics. The TUTORs are available for adults and children from the age of 5 and up and are fully certified by the FDA and CE. They can also be used in the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Innovative Treatments for Spinal Cord Injury Patients

Innovative treatments are needed for individuals with spinal cord injuries (SCI) and can lead to significant functional improvements in patients as well as give them a higher quality of life according to Sue Ann Sisto, PT, MA, PhD, Professor of Physical Therapy, Research Director, Division of Rehabilitation Sciences, Director of the Rehabilitation Research and Movement Performance (RRAMP) Laboratory,Stony Brook University School of Health Technology and Management (SHTM), Studies published in the September 2012 issue of ”Archives of Physical Medicine & Rehabilitation” show that innovative treatments for individuals with SCI can lead to several functional improvements in patients and also a higher quality of life. Dr. Sisto says the findings suggest that a shift in both protocol and policy is needed to advance and standardize rehabilitation for patients with SCI. “These studies provide evidence from many patients that long-term rehabilitation practices such as locomotor training, exercise, and wellness activities for patients with full or partial spinal cord injuries lead to improved health and function in patients,” according to Dr. Sisto. While most of the studies evaluate activity-based rehabilitative practices involving the assessment and the improvement of patients’ neurological or motor functioning, other studies evaluate patients’ overall health status. For example, researchers concluded ( in “Cardiovascular Status of Individuals with Incomplete Spinal Cord Injury from 7 NeuroRecovery Network Rehabilitation Centers,”) that a patient’s resting blood pressure and heart rate are affected by age, body position, and neurological level. They also found that one-fifth of patients had a quick drop in blood pressure because of a sudden position change from lying down to sitting up. Dr. Sisto says that practices like locomotor training, which consists of activities involving step training using body support on a treadmill, and with manual assistance, are valuable and show great promise for motor improvement in chronic spinal cord injury patients. New computer and other technologies, she says, are also helping to improve physical therapy and rehabilitation practices for patients, as well as help professionals more effectively chart patient progress. One of the innovative treatments as is recommended, is a physical therapy solution that is already in use in many leading U.S. and European rehabilitation centers and clinics. Referred to as the TUTOR system the devices are ergonomically designed gloves and braces placed on various affected limbs and then with sensors are connected to dedicated software. The software consists of specially designed games that allow the SCI patient to exercise his hand, wrist, elbow, leg, knee or any other affected limb. Also usable by patients suffering from Parkinson’s disease, MS, CP, stroke, brain injury or other upper or lower limb immobilities the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are physical therapy products that are monitored by therapists who then design a customized exercise program for that patient. The TUTORs are fully certified by the FDA and CE and can be used by adults as well as children from the age of 5. Patients having logistical difficulty or a desire to conduct their rehabilitation from home can do so through telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.