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.

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.

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 HandTutor system is being used to treat MS patients and the virtual task practice trains motor, sensory and cognitive movement impairments.

In the April edition of the J Int Neuropsychol Soc http://1.usa.gov/j8GFjG Dr. Benedict and his team from Buffalo School of Medicine, Department of Neurology, and the Jacobs Neurological Institute, Buffalo, New York found that processing speed and executive function tests were significant predictors of lower and upper motor function in both healthy and Multiple Sclerosis (MS) patients. The cognitive tests predicted variability in motor function after controlling for disease duration and physical disability which has implications for risk assessment and treatment of mobility dysfunction in MS.