Making the Case for Continuous Physical Rehabilitation for Parkinson’s Disease Patients

In a controlled clinical trial conducted by Comelia L. Cynthia , MD, Glenn T. Stebbins, PhD, Nancy Brown-Toms, BA and Christopher G. Goetz, MD of the Department of Neurological Sciences, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL. an evaluation was made of the effects of physical disability in moderately advanced Parkinson’s patients following 4 weeks of normal physical activity and 4 weeks of a more intensive physical rehabilitation program. They used a timed motor task and a standard assessment of PD severity (the Unified Parkinson’s Disease Rating Scale [UPDRS] with subscales for mentation, activities of daily living [ADL], and motor function. The test was conducted by an investigator who did not know about the physical rehabilitation status of the patient. Following physical rehabilitation, there was significant improvement in the UPDRS ADL and motor scores, but no change in mentation score. During the 6 months following physical rehabilitation, patients did not regularly exercise, and the UPDRS scores returned to their baseline. The conclusion the researchers reached was that physical disability in moderately advanced PD improves with a regular physical rehabilitation program, but the improvement is not sustained when normal activity is resumed. Parkinson’s disease patients have a physical therapy solution that has shown to be very effective in restoring movement ability to disabled limbs due to the disease. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3 DTUTOR are physical therapy products that are currently being utilized in leading U.S. and European hospitals and rehabilitation clinics. The TUTORs are gloves and braces that are strategically placed on affected hands, arms, elbows, legs and other joints. The sensors in these devices pick up the patient’s movements through dedicated software. Physical therapists monitor, evaluate and design these movements into a customized program for that specific patient. Fully certified by the FDA and CE the cost effective TUTORs are available for children as young as 5 and in the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

New Stroke Rehabilitation Device May Join Others Already In Use

Victoria University, New Zealand, masters student in engineering, Abigail Rajendran, 23, designed a stroke rehabilitation device and is working to market it. Rajendran believes that stroke patients will be able to rehabilitate themselves from home with the new device. With the device strapped on to a patient’s hand the goal is to exercise it in an opening and closing motion. A connected computer game activates at the same time and keeps both sides of the brain working. Once the patient regains the strength and can do the motion himself, he can increase the resistance with a special liquid contained in the device. Rajendran says that until now, stroke patients had to rely on expensive and large rehabilitation equipment only found in hospitals. However this device could be used regularly at home. Funding for a prototype has been provided by the Science and Innovation Ministry. Few, if any, home rehabilitation instruments are available for people recovering from strokes and new technology has to be made available according to Chief executive Sunil Vather. Apparently New Zealand stroke patients get only a few hours of therapy if they’re lucky and this device may afford them many more hours. Miss Rajendran will present her idea in Singapore later this month, and in Brisbane in October. The device may be ready for use in about a year. Apparently unknown to Miss Rajendran and her associates such physical therapy solutions already exist and are being used successfully in many leading U.S. and European and other hospitals and clinics. The physical therapy products known as the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been devised to allow intensive exercises to stroke victims as well as those afflicted with disabling Parkinson’s, MS, CP, brain/spinal cord injuries and other upper and lower limb paresis. The TUTORs are comfortable ergonomically designed gloves and braces that are attached to the affected areas of the body and then connected to a computer that has dedicated software in the form of games. These games are played with the active initiation of the patient himself and the results are recorded and evaluated by physical therapists who then design a specific exercise program for that patient. Since many patients have improved to the point where they no longer need hospitalization they and others who live too far from a rehabilitation clinic can avail themselves of the TUTORs at home through the use of telerehabilitation. In addition the TUTOR system is one of the most cost effective physical therapy products on the market today and they are small in relation to hospital based large equipment. The TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

Voluntary Exercises Better Than External Stimuli for Physical Rehabilitation

In the Journal of NeuroEngineering and Rehabilitation, July 2012 edition, Dr.Kyung-Lim Joa of the Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, South Korea published the results of a study in which rehabilitation was evaluated by using voluntary movements as well as Functional Electrical Stimulation (FES). Nineteen healthy male subjects were enrolled in the study. The study design included: a-voluntary contraction only, b-functional electrical stimulation (FES)-induced wrist extension only, and c-simultaneous voluntary and FES-induced movement. Brain activation was observed in all three modes. The activated brain regions (number of voxels) of the MI, SI, cerebellum, and SMA were LARGEST DURING VOLUNTARY CONTRACTION ALONE and smallest during FES alone. SII-activated brain regions were largest during voluntary contraction combined with FES and smallest during FES contraction alone. The brain activation extent (maximum t score) of the MI, SI, and SII was LARGEST DURING VOLUNTARY CONTRACTION ALONE and smallest during FES alone. The conclusions drawn were that voluntary contraction combined with FES may be more effective for brain activation than FES-only movements for rehabilitation therapy. In addition, voluntary effort is the most important factor in the therapeutic process. As it is this is another proof that the patient recovering from and undergoing rehabilitation for affected limbs due to Parkinson’s, CP, MS, stroke, brain or spinal injuries amongst other diseases and surgeries should be using physical therapy solutions that encourage the patient to use his own strength and efforts while exercising more than outside stimuli via robots or electrical impulses. Such physical therapy products can be found in the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been designed for just that type of intensive exercise. Consisting of comforatble and ergonomically designed gloves or braces, The TUTORs improve fine motor, sensory and cognitive impairments through intensive exercises with augmented feedback. The exercises are challenging and motivating and allow for repetitive training tailored to the patient’s own performance. In the case of the HANDTUTOR, for example, the glove has been designed to detect finger and wrist motion and has an open palmar surface to give maximum motor and sensory input. The glove comes in different sizes to allow evaluation and treatment of patients from age 5 and up. One of the most cost effective rehabilitation devices currently in use in leading U.S. and European hospitals the TUTORs are fully certified by the FDA and CE. They can also be used in the patient’s home via telerehabilitaion. See WWW.MEDITOUCH.CO.IL for more information.

Meaningful Task-Specific Training (MTST) Works With Stroke Rehabilitation

K.N. Arya etal of the Department of Neurology, CSM Medical University, Lucknow, India in a study published in Top Stroke Rehabilitation in the May/June 2012 edition discuss the following study they conducted. One of the functional challenges in post stroke patients is the upper extremity motor deficit. The objective of this study was to evaluate the results of the ”meaningful task-specific training” (MTST) on upper extremity motor recovery during the subacute phase after a patient suffers a stroke. The study was conducted as a randomized, controlled and double-blinded trial in the neurology department of a university hospital and occupational therapy unit of a rehabilitation facility. A sample of 103 people post stroke, was randomized into 2 groups (the MTST group had 51 participants and the standard training group had 52). Ninety-five of the participants completed the 8-week follow-up program. Participants were assigned to receive either the MTST or dose-matched standard training program based on the Brunnstrom stage and Bobath neurodevelopmental technique, 4 to 5 days a week for 4 weeks. The results showed a positive improvement in the scores of the MTST group at post and follow-up assessments in comparison to the control group. In addition, statistically significant differences were observed in changes between the groups at post and follow-up assessment for FMA, ARAT, GWMFT, and MAL. The conclusion drawn was that the MTST group produced statistically significant results as well as clinically relevant improvements in the upper extremity motor recovery of the patients who had had a subacute stroke. When providing physical therapy solutions for upper extremity movement disorders the ARMTUTOR is one of the leading and most cost effective products available. The ARMTUTOR™ has been developed to allow for functional rehabilitation of the upper extremity including the shoulder, elbow and wrist. The system consists of an ergonomic arm brace together with dedicated rehabilitation software. The ARMTUTOR™ system and its sister devices (HANDTUTOR, LEGTUTOR, 3DTUTOR) allows the physical and occupational therapist to report on and evaluate the patient’s functional rehabilitation progress and then to prescribe the correct customized and motivating intensive exercise practice to the manual rehabilitation therapy. Intensive repetition of movement is achieved through challenging games set to the patient’s ability. The system provides detailed exercise performance instructions and precise feedback on the patient’s efforts. 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. Telerehabilitation allows the recovering patient to continue his physical therapy at home. The system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See WWW.MEDITOUCH.CO.IL for more information.

Parkinson’s Disease–Not This Population

In the northern part of Israel and in Syria there is a group of people called ”Druse”. A new study by the University of Haifa and the Carmel and Rambam Medical Centers in Israel has found that the Druse people have a much lower incidence of Parkinson’s disease (PD) than in other populations. In addition it was found that this group suffers less from Essential Tremor (ET). This despite that the Druse tend to intramarry, a fact that usually brings with it higher genetic disease rates. Funded by the Israeli Ministry of Science and Technology the researchers found that the group is a “genetic nature reserve” since they have lived in the same general area for over 1,000 years and do not marry outsiders. Amongst the statistics is the fact that in the rest of the world ET affects an average of 4% of the poulation over 40 and PD an avaerage of 1.5%. The study was conducted with 9000 Druse who were 51 or over and who live in the Galilee section of Israel. Blood samples were taken from those who suffered from any kind of tremor. Of the group only 27 had full tremors and 9 had PD. The researchers were surprised at the low at the low percentage for a group of people that practiced consanguinity (marrying cousins). Normally such a group would be more likely to get PD and ET. A previous survey, though, discovered that genetically 150 different genealogical lines made up the community. This suggested to the researchers that because of so many lines when the community was originally formed it prevented the increase in genetic diseases. For those people who are not part of the Druse population Parkinson’s disease can be very debilitating. Fortunately there are physical therapy solutions that can offer some relief for PD symptoms. At the forefront is the HANDTUTOR. The newly developed HANDTUTOR and its sister devices (LEGTUTOR, ARMTUTOR and 3DTUTOR) have become a key system in neuromuscular rehabilitation and physical therapy for Parkinson’s patients as well as those affected by brain/spinal cord injury and other upper and lower limb disabilities . These innovative devices 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 and intensive training tailored to the patient’s performance and motor, sensory and cognitive movement ability. Customized and simple but powerful rehabilitation software allows the physical and occupational therapist the ability to adjust the program and exercise difficulty to the patient’s movement level. The system also includes objective quantitative evaluations that allow the physiotherapist and his occupational therapist colleagues to report on the patient’s exercise progress. Telerehabilitation features allow the patient to be supported by the physical rehabilitation team when he is at home. This ensures that the patient is motivated to do more practice between treatments by the therapists. The TUTOR system is suitable for children as well as adults. They are certified by the FDA and CE and are available for children as well as adults. See WWW.MEDITOUCH.CO.IL for more information.

The Risks of Mountain Bike Riding

In a microcosm study of mountain bike injuries Zachary Ashwell, a fourth year medical student who has a background in engineering, took statistics of injuries suffered by individuals who rode mountain bikes. An avid biker himself he knows the hazards and pitfalls that a rider can experience especially at Whistler Mountain Bike Park in Canada. He studied some 898 case reports from the Whistler Health Care Centre 2009 mountain bike season. The specific cases occurred between May 16 and Oct. 12 of 2009. He found that the typical injury was a 26-year-old male who suffered the injury between 1 and 4 p.m. Ashwell discovered that 86 per cent of the patients were male, that August is the worst month for injuries, that 12 per cent of the injuries suffered were considered potentially threatening to life, limb or function, and that more than 75 per cent of the bones broken in the bike park were upper body bones.The most severe injuries involved internal bleeding or internal organ injury, spinal cord injury or traumatic brain injury. Obviously the idea is to have as much safety gear as possible worn by the rider. Of 24 cases where safety equipment was noted only one was documented as not wearing armor. The other 23 were documented as wearing a variety of protective devices beyond a helmet, including knee and elbow pads, full body protective suits and neck guards. At the risk of divulging a possible business idea this writer suggests that someone should invent a kind of ”airbag garment” to protect the mountain bike rider when he falls. As stated above one of the more severe injuries that can occur to bike riders when they fall is Spinal Cord Injury (SCI) or Traumatic Brain Injury (TBI). When that occurs and the initial emergency treatment has passed the patient will need the best physical therapy solution to cope with any limb movement disability issue he has. The TUTOR system is in the forefront of such physical therapy products and has been developed to assist patients to get the most intensive exercises so that the limb can return to its former mobility stage (and the patient can again ride his bike??) The devices (HANDTUTOR, ARMTUTOR, LEGTUTOR, 3DTUTOR) are sophisticated, ergonomic and comfortable gloves and braces and have become a key system in neuromuscular rehabilitation and physical therapy for interactive rehabilitation exercise. The TUTORs are connected to exclusive software that implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. The physical therapist records and evaluates the progress made by the patient and designs a customized exercise program for that patient. The TUTOR system, fully certified by the FDA and CE is now part of the rehabilitation program of leading U.S. and foreign hospitals and can be used in clinics in their home through the use of tele-rehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Improving Brain Function After Stroke

Dr. Robert Rennaker and Dr. Michael Kilgard of the University of Texas, Dallas recently proved how nerve stimulation when paired with specific experiences, like movements or sounds, is able to reorganize the brain and even improve its function. What they discovered could lead to new treatments for stroke, autism, tinnitus, and other disorders. The researchers looked at whether by repeatedly pairing vagus nerve stimulation with a specific movement it would change neural activity in laboratory rats’ primary motor cortex. They paired the vagus nerve stimulation with movements of the front limbs in two groups of rats. After a period of five days of this stimulation and movement pairing, the researchers examined the brain activity of the rats. Those who received the training together with the stimulation displayed large changes in the organization of the brain’s control system. Those animals receiving identical motor training without stimulation pairing didn’t exhibit any brain changes, known as plasticity. Patients suffering from strokes or other brain trauma often have rehabilitation that includes repeated movement of the affected limb in order to regain motor skills. It is surmised that repeated use of the affected limb will cause reorganization of the brain which is essential to recovery. Dr. Rennaker stated that there was a suggestion from the research that pairing vagus nerve stimulation with standard therapy could result in a more rapid and extensive brain reorganization. This would offer the potential for speeding recovery following a stroke. He further stated “Our studies in sensory and motor cortex suggest that the technique has the potential to enhance treatments for neurological conditions ranging from chronic pain to motor disorders. Future studies will investigate its effectiveness in treating cognitive impairments”. Vagus nerve stimulation has an excellent safety record in human patients that suffer from epilepsy. Therefore the technique researched provides a new method to treat brain conditions such as dyslexia and schizophrenia. Future human patients may have access to more efficient therapies that are minimally invasive and avoid long-term use of drugs if the studies are confirmed. To provide repeated movement of a stroke affected limb the TUTOR system has been in the forefront of physical therapy products. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been developed to provide intensive and active movement of disabled legs, hands, wrists, elbows and other upper and lower limbs. The ergonomic gloves and braces that make up the TUTOR system are connected to dedicated software that 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 TUTOR rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows him to better perform everyday functional tasks to improve their quality of life. The TUTOR system is currently in use in leading U.S. and European hospital and clinics. They are fully certified by the FDA and CE and can be used at the patient’s home via telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Can Prayer Help Prevent Stroke?

Do you want to prevent having a stroke? One of the most important methods is to eliminate any risky practices you may have. Of course there are certain things we can’t change such as: genes, age and gender but we can change diet and physical activity. Adopting a diet which is low in salt and fat but high in fiber is a beginning. Vitamin B rich foods such as spinach, broccoli, carrots, salmon, herring, chicken, walnuts, almonds, sunflower seeds and whole wheat would be helpful. It is known that Vitamin B foods lower homocysteine levels and too much of this amino acid in the blood increases the risk for stroke. There are other foods that lower the risk of stroke and they include cinnamon, garlic, olive oil, onion, dark chocolates, green tea, oatmeal and strawberries. People that have diabetes should take necessary steps to prevent stroke as well. Diabetics are at risk and therefore should manage their diabetes by eating healthy and monitoring their blood pressure. Exercise is is a crucial element in stroke prevention as obesity is a stroke risk. Exercise will help take off pounds and maintain healthy weight. Cholesterol levels should be checked regularly. The state of one’s mental health can also increase stroke risk. Stress can be very damaging, if left unmanaged. It raises blood pressure, which makes the heart pump harder. One of the ways to reduce stress is with physical activity such as exercise or deep breathing. Reading and prayer or meditation can also relieve stress. Preventing high blood pressure is crucial to stroke prevention. That can be done by avoiding, or at least reducing, the consumption of high-fat foods such as: butter, red meat, eggs, shortening, certain cheeses and dairy products. Reducing the amount of salt is advisable. Sugar, caffeine and alcohol can raise blood pressure, which is a risk factor of stroke. Here are some common symptoms of stroke which, if experienced, should be brought to the attention of medical experts immediately. Sudden weakness or numbness in the face or limbs; slurred speech or drooling; numbness on one side of the body; problems with balance or walking; dizziness; confusion; or a severe headache. Unfortunately, even with the best prevention, stroke can still occur and one of the after effects can be the paralysis of a limb. When that occurs and after the patient is stabilized the emphasis will be to rehabilitate the leg or arm that is affected. Fortunately, today there are some very good physical therapy solutions such as the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. The TUTOR system has become key in neuromuscular rehabilitation for stroke victims and those recovering from brain and spinal injuries, Parkinson’s, MS, CP and other limb movement limitations. These innovative devices implement an impairment based program with augmented motion feedback that encourages motor learning through intensive active exercises and movement practice. They consist of a wearable glove or braces that detect limb movement showing the patient how much active or assisted active movement he is 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 to the patient in trying to gain this new movement objective. Consequently the patient understands which effort is more successful in getting him to move their affected limb again. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are now part of the rehabilitation program of leading U.S. German, Italian, French, UK and other foreign hospitals. They are adaptable for children as well as adults and are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

Prehabilitation–a Definition

PREVENTION & REHABILITATION: Two words that are not usually mentioned in the same breath. They actually are at opposite ends of the spectrum. However they really can go together because as much as rehabilitation serves to heal the injured, prevention or ”prehabilitation” can prevent the injury. To explain it further there are two areas of rehabilitation: a) Prehabilitation: which is exercise therapy undertaken by athletes and others to try to reduce the risk of injury. b) Rehabilitation: is exercise therapy which is used to strengthen muscles around limbs and thereby attempt to return the use of an affected limb to its previous healthy state and also to prevent the injury from recurring. This method can be used to build up muscles and reduce injury around the shoulder, arm, leg and other upper and lower limbs of the body. Players of contact sports such as Rugby in the UK or football in the U.S., as an example, can be the beneficiaries of such prehabilitation. Using the best physical therapy solutions for prehabilitation would add to the success of prevention of severe injuries. Such physical therapy products as the TUTOR system will afford the athlete and others to accomplish the goal of muscle toning and strengthening. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been introduced to provide intensive exercises for disabilities arising from stroke, CP, MS, brain/spinal cord injuries and other upper and lower limb injuries or diseases. The same TUTOR system can be used to exercise various muscles of the body on a regular basis to help prevent injury due to sports and other accidents. The TUTORs are ergonomically designed gloves and braces that are attached to various parts of the body and through powerful evaluation software accessed by sensors in the braces that allow the patient to perform intensive exercises. The exercises are monitored by physical therapists who then design a custom made program appropriate for that patient’s ability level. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are fully certified by the FDA and CE. They are available for children as well as adults and can be used in the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

How Much Salt to Add to Your Food

As published on Wednesday, April 25, 2012 in the journal STROKE, Dr. Francesco P. Cappuccio, of the University of Warwick in the UK stated that older adults with salty diets may have an increased risk of suffering a stroke. The results were in a study of 2,700 older, mostly minority adults. They got well above the recommended sodium intake and were nearly three times as likely to suffer a stroke over 10 years as people who met guidelines recommended by the American Heart Association (AHA). As people’s sodium intake goes up, their blood pressure will likely increase as well. What is not as clear, though, is whether a salty diet may mean higher risks of heart attack and stroke later on. Unlike blood pressure, which can change quickly, stroke and heart disease are more long-range complications. So a study of the relationship between people’s sodium intake and their risk of heart problems and stroke is more difficult. At this time, the AHA suggests that people not consume more than 1,500 milligrams a day. The World Health Organization advises a limit of 2,000 milligrams. The people in this study — mainly black and Hispanic New Yorkers — consumed 3,031 milligrams of sodium per day. The findings are based on 2,657 adults who were interviewed about their health and lifestyle and then completed dietary questionnaires. They were 69 years old, on average, when the study began. During the next 10 years, there were 235 strokes in the group. Those that downed 4,000 or more milligrams of sodium each day were almost three times more likely to suffer a stroke as those who kept their daily sodium below 1,500 milligrams. Among the 558 people consumed more than 4,000 milligrams per day, there were 66 strokes. That compared with 24 strokes among the 320 people who kept within the AHA guideline. Hannah Gardener, a researcher at the University of Miami School of Medicine who led the study said “We can’t definitively draw conclusions about cause-and-effect . There can be a number of other factors to take into consideration in addition to salt intake. As an example smoking habits, exercise levels, education and health conditions like diabetes and high blood pressure need to be taken in to consideration. Although few Americans adhere to the AHA guidelines they should be followed according to Gardener. Interestingly, it’s estimated that the typical U.S. man takes in 4,000 milligrams of sodium a day, while women typically ingest 2,800 milligrams. Salt is pervasive in the food supply — from canned soups and sauces, to breads and cereals, to processed meats — and it can be challenging to cut down. Americans receive almost 80 percent of their sodium from prepared foods on supermarket shelves and in restaurants, rather than at home. Gardener further states that it is important to read product labels to know beforehand how much sodium there is in the product. Eating fruits, vegetables and whole grains, as much as possible will also alleviate the problem. The researchers suggest that responsibility should also rest on government regulations and the food industry. In England, the government has begun to regulate the processed food industry. New York City has instituted the National Salt Reduction Initiative. This move tries to coordinate local and state governments and health groups to work with the food industry to cut sodium in packaged foods and restaurants. Heinz, Kraft Foods and Starbucks, have already signed on to meet salt targets. Unfortunately, at this time and age people still take in too much sodium so strokes will still occur. When they do and the initial medical treatment is completed it behooves doctors and other medical staff and facilities to supply the best physical therapy solutions available to treat any paralysis that may exist as a result of the stroke. Such physical therapy products are the TUTOR system. Rehabilitation using the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR is instituted in the USA at major in-patient and out-patient clinics as well as at private physical therapy clinics. Many patients including stroke victims can also avail themselves of the TUTOR system through the use of tele rehabilitation when they are at home or in a location far from a qualified rehabilitation center. The TUTOR products have 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 controlled exercise practice. The TUTOR system exercises multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement. It therefore ensures better performance of functional tasks. This is important in stroke, brain, spinal cord (SCI) and Cerebral Palsy rehabilitation in addition to other neurological and orthopedic injury and disease. Additional features of the TUTOR system include quantitative evaluation and objective follow up that is important in the physiotherapists treatment of the stroke patient. The TUTORS are FDA and CE certified and are available for children as well as adults. See WWW.MEDITOUCH.CO.IL for more imformation.

Acquired Brain Injury–What is it and What Can Be Done?

Many people suffer from brain injury which usually is caused by a traumatic event such as an accident or fall. However there is also what is called Acquired Brain Injury which can be a result of a stroke, tumor or infectious disease. It was announced on July 10 that in London a campaign has begun by the United Kingdom Brain Injury Forum (UKBIF) that will highlight the need for easier and earlier access to rehabilitation for ABI patients. The aim of the campaign is to improve existing services and to do more for these unfortunate individuals. It is known that the effects of ABI include physical, emotional, sensory and cognitive problems. Also that the effects can be temporary, permanent, light or severe. Sometimes the disabilities are not obvious. Results may include relationship breakdowns, loss of employment and change of personality. In the UK alone approximately 150,000 people per year have some kind of brain injury and the costs for ABI care was more than 1 billion pounds Sterling just in hospital costs in 2007. Community care and rehabilitation cost another 4 billion pounds. One factor that is known about brain injury is that early rehabilitation may help to reduce length of hospital stays. Because of these facts it is important that all costs for future care are available and that the highest standard of care and rehabilitation be administered. One of the latest physical therapy solutions is the TUTOR system. It is very cost effective and therefore can keep the costs of rehabilitation down while affording the patient the best of care. The TUTORs which include the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomically designed gloves and braces that are strategically placed on the affected part of the body and then through exclusive software the patient can exercise his affected limb. Physical and occupational therapists monitor this activity and record and evaluate the patient’s progress and then design a custom made exercise program for the patient at his ability level. The TUTORs are available for adults as well as children, are fully certified by the FDA and CE and can be used at home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Alcopop–what is it and what does it do?

A not so new but dangerous trend has begun appearing that affects teenagers around the world. ALCOPOP is an alcoholic drink that tastes like a soft drink. The sweetness masks the alcohol. Also known as ”girlie drinks”, clear malts, flavored malts and ”cheerleader beer”, alcopops are used by more girls than boys. Children as low as 13 and sometimes lower are exposed to it. Teenagers in the ever longing quest to become an adult as fast as possible love to imbibe when they are in social gatherings and family events. Drink advertisers disseminate their products on TV before 9 p.m. when there is a large teenage audience. Alcopops are a soft entry to the hard world of alcohol. The ramifications are enormous. Statistics have shown that a meaningful percentage of teens get into risky situations following the drinking. Aside from the fact that they become educated into the world of alcoholism they also run into trouble at a young age when they get into cars and begin driving under the influence of liquor. Even if they don’t drive they accompany friends who drive after having had several alcoholic beverages. The risk of accidents and unwanted sexual activity increases in proportion to the amount they drink. If there is no parental or other supervision the child will continue with this habit into adulthood. Just one of the long term results of this phenomenon is brain impairment. It also can cause liver disease, cardiac problems and, of course, alcoholism with all its ramifications. If, unfortunately, a brain injury occurs then after the initial treatment is over and rehabilitation begins one of the best physical therapy products available today is the TUTOR system. The recently developed HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) have become a key system in neuromuscular rehabilitation for brain and spinal injuries and other limb movement limitations. These innovative devices implement an impairment based program with augmented motion feedback that encourages motor learning through intensive active exercises and movement practice. The HANDTUTOR, ARMTUTOR, LEGTUTOR, 3DTUTOR consist of wearable glove and braces that detect limb movement showing the patient how much active or assisted active movement he is actually doing. The rehabilitation software uses special rehabilitation games to set a new target for this movement in terms of the patient’s ability to move his limb. The devices then measure the limb movement and give feedback on the success of the patient for this new movement objective. In this way the TUTOR system provides exercises that are challenging and motivating and allows for repetitive and intensive exercise practice. The TUTOR system is now part of the rehabilitation program of leading U.S. German, Italian, French, UK and other foreign hospitals. Exercises can be done from the patient’s home through the use of telerehabilitation. The devices are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

Don’t Underestimate Pre Knee/Hip Surgery Exercises

All those that undergo knee or hip replacement surgery need to get into anexercise program following surgery. However it is equally important to have an exercise program prior to these surgeries as well so as to strengthen the muscles around the joint. This will both enhance the recovery and properly support the new joint. How much exercise to do is an individual choice and will depend on a number of factors. If the exercise causes pain it would be better to curtail it. It is preferable to exercise once or twice a day every day before surgery and to do five repetitions of each exercise and then gradually increase them until the actual date of surgery. Doing the exercises in bed lying down is excellent. Your doctor or physical therapist can prescribe specific exercises for your condition. An excellent plan would be to use the LEGTUTOR as a physical therapy product as it has a reputation for ease and comfort. The LEGTUTOR consists of a safe and comfortable leg brace with position and speed sensors that precisely record 3 dimensional hip and knee movements. The LEGTUTOR has a range of motion limiter that can limit the dynamic range of 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 LEGTUTOR together with its sister devices (HANDTUTOR, ARMTUTOR and 3DTUTOR) are currently used successfully in leading U.S. and European hospitals for a variety of disabilities including stroke, CP, MS Brain and Spinal cord injury and others affecting the upper or lower limbs. The TUTOR sytem is available for children as well as adults and are fully certified by the FDA and CE. The TUTORs can also be used at home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Closed and Open Chain Exercises as a Prelude to Knee and Hip surgery

Closed chain exercises are physical exercises performed where the hand (for arm movement) or foot (for leg movement) is fixed in space and cannot move. The extremity remains in constant contact with a stationary surface, usually the ground or the base of a fixed object. The opposite of closed chain exercises are open chain exercises. Closed chain exercises are considered safer and more “functional” compared to open chain exercises. Nevertheless, the two families of exercises can co-exist in enabling rehabilitation and strengthening objectives. Closed chain exercises are often compound movements, that generally incur compressive forces, while open-chain exercises are often isolation movements that promote more shearing forces. Closed chain exercises involve more than one muscle group and joint simultaneously rather than concentrating solely on one, as many open chain exercises do (single-joint movements), lending the former to more utilitarian and athletic activities. Open Chain Exercises allow the hand or foot freedom to move (like a chest press). These types of movements tend to isolate a single muscle group and a single joint. For example, the one joint involved during a leg extension is the knee and the muscle group it isolates is the quadriceps. Open chain exercises can be done with or without added weight, but when weight is added, it’s usually placed at the distal (far away) portion of the limb (like the ankle). Examples of open chain exercises include chest presses, biceps curls, leg curls, and leg extensions (with or without added weight). In Closed Chain Exercises the movements of hands or feet are in a constant, fixed position (usually on the ground) during the exercise (such as pushups). Closed chain exercises work multiple joints and multiple muscle groups at once. For example, a squat involves the knee, hip and ankle joints, and multiple muscles groups (quads, hamstrings, hip flexors, calves and glutes). Closed chain exercises can be done with body weight alone or with added weight. When external weight is added, it is usually rested across the back of the shoulders or the front of the chest, which is considered much safer than the “distal” placement of weight during open chain exercises. Examples of closed chain exercises include pushups, pull-ups, squats, and lunges, all of which can be done with or without added weight. These exercises are useful for several purposes and can either strengthen knee and hip muscles prior to replacement and may even be able to prevent the surgery completely. When exercising the various muscles it would be very helpful to use the most effective physical therapy products available. Specifically the TUTOR system of products (HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR) have been designed to strengthen and revitalize limb muscles that may have been compromised over time by arthritis, Parkinson’s disease, CP, MS, brain or spinal cord injuries, tendon transfers, complex regional pain syndrome and others. The TUTOR system consist of ergonomic wearable devices together with powerful dedication rehabilitation software. The system is indicated for patients in rehabiliation centers, private clinics and the home and can be supported by telerehabilitation. The TUTORs 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 devlopment of compensatory movement patterns. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. The TUTOR system is fully certified by the FDA and CE and is available for children as well as adults. See WWW.MEDITOUCH.CO.IL for more information.

Physical Therapy for Multiple Sclerosis Patients

What role does physical therapy play in treating MS? Physical therapy can help with Balance problems Coordination issues Fatigue Pain Weakness Difficulty with physically performing daily activities (such as walking or getting up from a sitting position) Posture The goal of physical therapy is to improve independence and quality of life by improving movement and function, and relieving pain. We don’t know why yet but Multiple Sclerosis (MS) damages the myelin sheath surrounding the nerve cells of the brain and spinal cord. Scarring from this damage can block or slow nerve impulses in areas of the brain (neurological damage). As a result, an MS patient may lack coordination, feel tired, have involuntary movements, resist movement (spasticity), and have pain. Symptoms such as these, which are a result of MS, are called “primary symptoms.” Primary symptoms can reduce movement. As a result, one may feel tightness, pain and weakness, especially in the muscles and joints. These are called “secondary symptoms”. Physical therapy cannot cure primary symptoms because, at this time, neurological damage cannot be reversed. Physical therapy can be helpful, though, by providing “compensatory” treatments. These treatments enable the patient to compensate for the changes brought about by MS. Compensatory treatments include learning new movement techniques, strategies, and equipment. Physical therapy can be very helpful at lessening and even stopping secondary symptoms of MS. A physical therapist can teach exercises to be used to strengthen and stretch muscles. Many of these exercises can be performed at home. A physician can refer the patient for physical therapy if the patient feels there may be benefit from it. The number of PT appointments depends on the specific situation. The first appointment includes an evaluation and recommendations for exercises. The following appointments check your progress and build a new program. The therapist will work with the patient until a certain level of improved function is reached. At that point, a home exercise program may be developed. When choosing the right physical therapy solution it is vital to incorporate the best physical therapy products. Such a product is the TUTOR system. Currently being used for the treatment of MS as well as CP, stroke, brain/spinal cord injury, Parkinson’s disease and other upper and lower limb surgeries the TUTORs are amongst the leading medical devices for physical therapy. The TUTORs which consist of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR consist of comfortable ergonomically designed gloves and braces that are connected to exclusive games that allow the patient to practice isolated and/or interjoint coordination exercises. Controlled exercises prevent the development of compensatory movement patterns. The dedicated software allows the therapist to fully customize the the exercises to the patient’s ability. In addition the therapist can objectively and quantitatively evaluate and report on the treatment progress. The TUTOR system is available for children as well as adults and in the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

The Knee Ligaments and Their Rehabilitation After Injury

The anterior cruciate ligament (ACL) is one of the four major ligaments of the human knee. When it is injured the doctor or even physical therapist will design a physical rehabilitation (rehab) program that takes into consideration what the normal level of activity is usually like, the state of physical fitness, and the extent of the anterior cruciate ligament (ACL) injury itself. Such a rehab program should include: flexibility exercises, strengthening exercises, endurance activities and coordination and agility training (for competitive athletes)., The program should function until all of the muscles in the injured leg should be as strong as in the uninjured leg before one returns to normal activities. The program usually includes treatment with a physical therapist at a therapy center, home treatment, at a gym or health club. Generally, the less one sees the therapist, the more one does on his own. The extent of the recovery from an ACL injury depends on how severe the injury was originally, how extensive the surgery was, and how consistent one is in the follow up program. The rehab program normally lasts from 4 to 6 months. People who are more consistent with their program make a faster recovery and have fewer knee problems in the future than those who do not complete their program. Rehabilitation is needed after most ACL injuries, regardless as to whether surgery takes place. Rehabilitation programs strengthen the knee and the muscles around it which leads to better knee stability, and may also return normal range of motion and flexibility to the knee. How well a rehab program works depends on whether one does rehab only or has surgery plus a rehab program. It is important to establish what to expect from the rehab program. This depends on age, the extent of your injury, whether other knee injuries are present, and overall health. In rehab only, some people are able to regain enough stability in their knee to continue their normal activities and are able to avoid surgery. Other people have poor results, never regain knee stability, and either decide to have surgery or quit their activities or sports. If rehabilitation is done without surgery, there is a greater chance that the ACL may be injured a second time., Athletes who have surgery followed by complete rehab are more likely to return to competitive sports than those who only do rehab. It is vital to have the rehabilitation program well supervised to ensure that the exercises are appropriate and the progression is appropriate. The risks of a speedy rehab program may weaken the reconstructed ligament, and starting sports training too soon. If the rehab program is not completed, there is a risk of having an unstable knee and reinjuring it in the future. Physical rehabilitation for an ACL injury is extensive. Some people consider it like having a second job., To the extent that one participates in a rehab program, knee surgery may be avoided because strengthening the muscles in the front (quadriceps) and back of the thigh (hamstrings) will support the knee. If surgery is eventually needed though, one will be much better prepared for surgery and rehabilitation after surgery. It is important to know that not all physical rehabilitation programs are the same. In the field of physical rehabilitation it is important to have access to the best physical therapy solutions in the sense of the most efficient tools that are available. Included in such physical therapy products is the LEGTUTOR. The LEGTUTOR consists of a safe and comfortable leg brace with position and speed sensors that precisely record three dimensional hip and knee movements. The LEGTUTOR has a range of motion limiter that limits the dynamic range of knee extension and flexion. Rehabilitation games allow the patient to exercise range of motion, speed and accuracy movement. The LEGTUTOR facilitates evaluation and treatment of the lower extremity including isolated and combined hip and knee movements. The TUTOR system (of which the LEGTUTOR is one component, the others being the HANDTUTOR, ARMTUTOR and 3DTUTOR) is one of the most cost effective physical therapy solutions.These physical therapy products are also used for patients with Parkinson’s disease, stroke, brain or spinal cord injury and other upper and lower limb surgery rehabilitation. The TUTOR system is currently in use in leading U.S. and European hospitals and clinics. The TUTOR system is available for children as well as adults and can be used at the patient’s home through terehabilitation. The TUTORs are FDA and CE certified. See WWW.MEDITOUCH.co.il for more information.

Diabetes Drug for Brain Injury Discovery

On June 24, 2012 it was reported that a new diabetes drug-called Exendin-4 which has been approved by the FDA significantly minimizes damage in Traumatic Brain Injury (TBI) in laboratory animals. The project was commissioned by the U.S. Air Force. The principal researchers are Prof. Chaim Pick of Tel Aviv University’s Sackler Faculty of Medicine and Dr. Niguel Greig of the U. S. National Institute of Aging. Although the death toll in people who suffer from TBI is relatively low, it can have severe, lifelong consequences for brain function. As a result of TBI a patient can have impaired mental abilities and dramatic personality changes. This aside from the high financial cost of treatment. Originally Exendin-4 was designed to control sugar levels in the body but it has shown to be effective in alleviating symptoms of Alzheimer’s disease and it was found that if administered shortly after the original incident it can minmize damage in TBI. Together with collaborators, Dr. Vardit Rubovitch, Lital Rachmany-Raber and Prof. Shaul Schreiber and Dr. David Tweedie of the U.S. Institute the study and results have been published in the journal Experimental Neurology. The research has been going on for several years and consisted of the effects of injuries when hitting the windshield in a car accident as well as work for the U.S. military in relation to trauma sustained when someone is exposed to an explosion or terrorist attack. In the experiments it was shown that mice that were exposed to blasts but that received Exendin-4 had significant reduction of brain damage caused by the explosion. An improved outcome was also associated when the mice sustained TBI by blunt force if given the drug . The plan now is to find the right dosage and delivery system and to find other drugs to complement Exendin-4 to increase its efficiency. TBI can have debilitating effects on limb movement and when that occurs the best physical therapy solutions are needed to provide exercises for the patient. The most cost effective physical therapy poducts are incorporated into the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are comfortable ergonomically designed gloves and braces that are placed on strategic locations of the body. They have position and speed sensors that precisely record finger and wrist movement. Rehabilitation games allow the patient to exercise range of motion, speed and accuracy of movement including opposition and pinch movement practice. The software gives the physical therapist objective and quantitative information which then allows an exclusive exercise treatment plan to be designed. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are also used by patients that have impaired limb mobility due to stroke, Parkinson’s, CP,MS, spinal cord injury and other upper and lower surgeries. Currently in use in leading U.S. and European hospitals and clinics the TUTOR system is FDA and CE certified and is available for children as well as adults. The patient is also able to use the TUTORs from home, if necessary, through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

A ”Pacemaker” for Parkinson’s Patients

In line with the international effort to combat symptoms of Parkinson’s disease, it was announced on June 20, 2012 that Professor Hagai Bergman of Jerusalem’s Hebrew University’s neurobiology department had been able to surgically implant a battery operated neurostimulator, similar to a heart pacemaker, to deliver electrical stimulation to specific parts of the brain that control movement. This tiny device blocks the abnormal nerve signals that cause the severe shaking and other symptoms that Parkinson’s patients experience. About 0.4% of the Israeli Parkinson’s population had already received the new device but there was further adjustment necessary. For Parkinson’s patients that are not acceptable for this procedure and for those that are still waiting for the special surgery other methods are needed to counter the debilitating movements that are prevalent with this disease. When these latter patients are in need of physical therapy solutions the TUTOR system comes in handy. The TUTORs, which consist of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR, are comfortable ergonomic gloves and braces placed on various limbs of the body and are connected to a computer with dedicated software that allows the patient to get intensive exercises. These exercises are in the form of 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 the therapist can objectively and quantitatively evaluate and report on 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 TUTORs are currently used in leading U.S. and European hospitals and clinics to treat patients that have Parkinson’s disease as well as CP, MS, stroke, brain and spinal cord injury and other upper and lower limb disabilities. The TUTORs are one of the most cost effective physical therapy tools on the market and are fully certified by the FDA and CE. They are available for adults as well as children and can be used at home via telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Rehabilitation: What Does it Actually Mean?

Rehabilitation can mean many things to many people. A building that is old and rundown needs to be rehabilitated, a criminal during his imprisonment is hopefully rehabilitated so he can return productively to society, a person accused of some scandal needs to be rehabilitated back into the good graces of the society he came from. Rehabilitation , obviously, also means physical rehabilitation after a severe injury or disease. In the latter situation it isn’t enough for the patient to be hospitalized for a period of time and then return home. There is a very complicated process performed by very highly trained individuals that work as a team to assure that the patient is able to function as close to his normal ability as possible. Traumatic spinal cord injury (SCI) is perhaps one of the most devastating orthopedic injuries and the primary goals of rehabilitation are: a) prevention of secondary complications, b)maximization of physical functioning, and c)reintegration into the community. SCI rehabilitation is most effective with a multidisciplinary, team-based approach, as follows: Physical therapists typically focus on lower extremity function and with mobility functions. Occupational therapists are involved with upper extremity dysfunction and difficulties in activities of daily living Rehabilitation nurses are concerned with issues of bowel and bladder dysfunction and managing pressure ulcers Psychologists deal with emotional and behavioral concerns of the injured patient and with any potential cognitive dysfunction Speech-language pathologists focus on issues of communication and swallowing Case managers and social workers are the primary coordinators between the rehabilitation team, the patient and family, and the financial source. A physiatrist manages the whole team. He is a physician who specializes in physical medicine and rehabilitation. While each team member has primary responsibilities, any other member of the team can contribute to the resolution of any problem. When it comes to choosing the most appropriate physical therapy tools the team would hopefully consider the most cost effective and efficient devices on the market. Such a tool would be the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are used extensively in Spinal Cord Injury rehabilitation. 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 system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. Controlled exercise practice helps 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 and can be adapted to children as well as adults. See WWW.MEDITOUCH.CO.IL for more information.

The Effects of Traumatic Brain Injury on Fatigue and Sleepiness

Simon Beaulieu-Bonneau and Charles M. Morin of the École de psychologie, Université Laval, Pavillon Félix-Antoine Savard 2325, rue des Bibliothèques, Québec, Canada conducted a study comparing individuals who suffered from a traumatic brain injury (TBI) to healthy controls (CTLs) measuring sleepiness,fatigue, and sleep and exploring the relationship between each group. There were 22 adults with moderate to severe TBI and 22 matched healthy CTLs. They underwent one night of polysomnographic (PSG) recording of their sleep followed the next day by the Maintenance of Wakefulness Test (MWT). They also completed a 14-day sleep diary, the Epworth Sleepiness Scale (ESS), the Functional Outcomes of Sleep Questionnaire (FOSQ), and the Multidimensional Fatigue Inventory (MFI). The results showed that there were no significant group differences on measures of subjective or objective sleepiness, both groups being quite alert. However, TBI participants reported greater consequences of sleepiness on their general productivity, spent more time in their bed at night, and napped more often and for longer periods of time during the day. Subjective fatigue was significantly higher in TBI participants on the general, physical, and mental fatigue MFI subscales. There were no between-group differences on any sleep parameters derived either from PSG or sleep diary. The conclusions they reached were that fatigue appeared to be a more prominent symptom than sleepiness when it was assessed between 1 and 11 years after TBI. Patients that participated who suffered from TBI used compensatory strategies such as increasing time spent in bed and napping during the day in this sample. When TBI causes immobility of a limb the appropriate physical therapy solution should be found. For example the TUTOR system of physical therapy products know as the: HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are used extensively to accomplish the proper exercise program. Physical rehabilitation is being done in the USA at major rehabiliaiton in-patient and out-patient clinics as well as at private physical therapy clinics. Many patients who have had a TBI or stroke, cerebral palsy or spinal cord injury can also avail themselves of the TUTOR system through the use of tele rehabilitation. These physical therapy products have 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 provides patient instructions and feedback to encourage intensive and controlled exercise practice. In this way, the TUTOR system allows for exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and therefore ensures better performance of functional tasks. This is important in stroke, brain, spinal cord (SCI) and Cerebral palsy rehabilitation in addition to other neurological and orthopedic injury and disease. Additional features of the TUTOR system include quantitative evaluation and objective follow up that is important in the physiotherapists treatment of the exercises. For additional information see WWW.MEDITOUCH.CO.IL