LegTutor system improves functional lower extremity movement ability in stroke patients

Stroke is among the most common causes of adult-onset impairment and disability. Motor impairment affects most stroke survivors and causes functional disability. Physical and Occupational therapists implement therapy based on scientific knowledge of motor capacity, motor control, and motor relearning. By using theory-driven approaches to treatment clinicians are translating basic sciences into novel clinical practice and building on methods to manipulate the remarkable plasticity of the brain. Examples of therapy used includes, task oriented training, task-related practice, robotic trainers, electrical stimulation. The HandTutor and ArmTutor system is proven to improve upper extremity function in patients with arm movement dysfunction in both rehabilitation clinic and the home. The introduction of the LegTutor system allows for customized intensive lower extremity movement practice and improved functional ability outcome.

ArmTutor, HandTutor and LegTutor systems used in inpatient and outpatient to treat Apraxia

In the April edition of Neurorehabilitation http://bit.ly/jo56wP Dr. Vanbellingen and Dr. Bohlhalter from the Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland define Apraxia as a higher-order motor disorder impairing the ability to correctly perform skilled, purposive movements as the result of neurological disorders most commonly stroke, dementia and movement disorders. It is increasingly recognised that apraxia negatively influences activities of daily living (ADL). Early diagnosis and treatment should be part of the neurorehabilitation programme. In their article they describe the most important subtypes of apraxia such as ideational and ideomotor apraxia as well as their impact on ADL and outcome. Furthermore, the relationship to associated disorders such as aphasia is discussed. Finally, strategies concerning assessment, management and treatment of the disorder are presented.
The HandTutor, ArmTutor system improve arm and hand functional ability and quality of life. The LegTutor system is used in inpatient and outpatient to treat knee and hip movement ability.

The LegTutor system is used to customize isolated and coordinated knee and hip exercises and is used to improve patient functional walking ability

In the April edition of Physical Medicine and Rehabilitation http://bit.ly/iJ4Fzr, Dr Watt and his team from Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA discuss Effect of a Supervised Hip Flexor Stretching Program on Gait in Elderly Individuals.
The group looked at eighty-two healthy elderly individuals, with 39 subjects in the control group and 43 subjects in the treatment group. The treatment group completed a 10-week, twice-daily hip flexor stretching program, which was supervised twice weekly by a rehabilitation clinician. The 10-week supervised hip flexor stretching program was effective in increasing stride length and peak hip extension during walking in elderly adults who had limited preintervention hip extension during walking. These results support the use of a simple stretching program for elderly individuals in counteracting age-related decline in gait function.
The LegTutor system is used to customize isolated and coordinated knee and hip exercises and is used to improve patient functional walking ability.

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.

Exercising isolated and coordinated hand movment impairments using the HandTutor improves functional movement ability

In the April edition of Journal of NeuroEngineering and Rehabilitation http://bit.ly/iLXFlB Dr. Carpinella and her team from LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Milan, Italy compared spatial and temporal aspects of hand movement in 12 healthy volunteers and 14 hemiplegic stroke survivors.
The group found that in comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted.
The HandTutor system trains isolated and coordinated hand movement impairments in a motivating and challenging environment that promotes exercise practice in order to better achieve functional hand movement ability so that the patient can better perform everyday living tasks.

LegTutor and 3DTutor indicated for Active Movement Rehabilitation of Lower-Limb Impairments in Children With Cerebral Palsy

In the May edition of Neurorehabilitation and Neural Repair http://bit.ly/equBpT Dr. Yi-Ning Wu from Rehabilitation Institute of Chicago, Chicago, IL, USA and Dr. Miriam Hwang from Korea University College of Medicine, Seoul, Korea study Combined Passive Stretching and Active Movement Rehabilitation of Lower-Limb Impairments in Children With Cerebral Palsy using a portable robot. The group found that Passive stretching combined with engaging in active movement training was of benefit in this pilot study for children with CP. They demonstrated improvements in joint biomechanical properties, motor control performance, and functional capability in balance and mobility.
The LegTutor and 3DTutor trains isolated and combined hip, knee and ankle movement and focusses on leg motor control in order to improve functional walking outcome.

The HandTutor system is being used effectively to mprove fine and gross motor performances of the upper limb in people with Parkinson disease.

In the May edition of American Journal of Physical Medicine & Rehabilitation http://bit.ly/hu8GqN Dr. Lee, Kyoung-Suk and is team from the Department of Physical Therapy, College of Health Science and Social Yonsei University Korea discuss the use of Modified Constraint-Induced Movement Therapy to improve Fine and Gross Motor Performance of the Upper Limb in Parkinson Disease.
The group concluded that Modified constraint-induced movement therapy improves fine and gross motor performances of the upper limb in people with Parkinson disease. Therefore, the therapy would be recommended as an effective treatment for them.

What is the difference between traditional therapeutic task practice used in constraint induced movement therapy and virtual functional task practice of the arm and hand with the HandTutor system?

Intensive and massed exercise practice has been proven to improve patient movement ability and the ability to do everyday living tasks. The HandTutor system employs virtual functional tasks. These are computer generated tasks or games that have been formulated to allow the therapist to customize which joint or combination of joint and which movement parameter will be exercised during the practice. In other words virtual functional tasks can be customized according to the patients movement ability. Therefore patients with very limited or no active movement ability can, through active assisted exercises, undertake intensive and massed movement practice. Similarly if the patient has better movement ability but still needs to work on pushing this ability to its limit the virtual tasks can be customized so that the patient needs to employ for example his maximum range of movement and or his maximum speed of opening of the fingers in order to succeed in the repetitive task. While the patient is performing the task they continue to receive instructions on how to do the task, how to correct compensatory movement patterns as well as feedback on their success in completing the task or adhering to the task requirements. This feedback is known as augmented motion feedback and teaches the patient how to move their arm and hands again.

The HandTutor system is being used effectively to mprove fine and gross motor performances of the upper limb in people with Parkinson disease.

HandTutor used with mental practice to improve hand movement ability

Mental practice or movement imagination is a training method where the patient imagines a movement without actually moving the limb that has movement dysfunction. Recently researchers have proposed the use of mental practice to facilitate motor recovery in stroke patients and other patients with motor disorders. Mental practice is the imagined rehearsal of a movement with the specific intent of improving that movement and it is suggested that during mental practice the motor control structures in the brain are activated in more or less the same way as during the actual performance of movements. This mechanism of improving limb movement has been reinforced by neuroimaging studies taken during motor imagery and show that the same brain areas are active as during actual movement. In addition, studies with healthy individuals have shown that motor imagery and actual action share some striking similarities. When someone is asked to perform a movement, for example, “walk along this line”, and to imagine the same movement, the time to complete the actual walking movement is similar to the time needed for completing the imagined walking movement.

HandTutor system answers the 2009 American Heart Association (AHA) Policy Statement on stroke systems of care

In 2009 the American Heart Association issued a AHA Policy Statement that appears in Stroke magazine http://stroke.ahajournals.org/cgi/content/full/40/7/2635 discussing recommendations for the implementation of telemedicine within stroke systems of care. In regards to sub acute stroke treatment, the report states that many small hospitals do not have specialists with training and expertise to treat patients in medical sub specialties, including physical, occupational and speech therapy, and rehabilitation medicine.
Stroke rehabilitation involves coordinated interventions from a multidisciplinary team in order to achieve the best potential functional outcome. and should be provided by an appropriately trained and staffed that follows established practice guidelines. Impaired recovery outcomes has been noted in patients with geographically and or financially limited access to appropriate rehabilitation services. The report concludes that telemedicine for rehabilitation (telerehabilitation) may be a practical and valuable approach to delivering post stroke care when limited resources, manpower shortages, long distances, or limited patient mobility prevent or limit access to indicated rehabilitation therapies.
In a recent statement by Steven L. Wolf, PhD, professor of rehabilitation medicine at Emory University School of Medicine millions of Americans face challenges in accessing health care, with rural residents experiencing more limitations of activity caused by chronic conditions such as stroke than urban residents. Additionally, insurance carriers often do not cover lengthy rehabilitation programs for stroke survivors, causing many patients to lose the proven benefits of aggressive therapy following a stroke.
Prof Wolf also states that “A tremendous amount of research has led to advances in stroke therapy through the identification of the importance of task practice and intensity of therapy. However, we know that many patients, in particular those living in rural and under served areas, do not receive quality post-stroke rehabilitation.

The EU policy states all European stroke patients should have access to a continuum of care, including organized acute stroke units, appropriate rehabilitation, and secondary prevention measures and the 2006 World Health Organization Helsingborg Declaration on European Stroke Strategies declared that tele-rehabilitation is a vital element to achieving this goal.
The HandTutor system is being used for stroke and other brain and spinal cord injury, cerebral palsy, brachial plexus injury patients, with the patient undergoing intensive exercise practice at home with tele-monitoring from a remote location ensuring patient compliance and maximum motivation.

HandTutor and ArmTutor systems used to give customized and motivating intensive exercise practice

In the March edition of Clinical Rehabilitation http://bit.ly/hC2IvQ, Dr. Stephen Page and his group from the Departments of Rehabilitation Sciences, Physical Medicine and Rehabilitation, University of Cincinnati Academic Medical Center, Cincinnati, OH, USA compare longer versus shorter mental practice sessions for affected upper extremity movement after stroke. The group found that regardless of dosing condition, subjects administered mental practice exhibited markedly larger score changes on both the FM and ARAT than subjects not receiving mental practice.
Mental practice can be used in Arm and HandTutor system treatments as the dedicated rehabilitation devices allow the therapists to tailor and customize the patients exercise to their movement ability. This keeps the patient motivated to continue intensive exercise practice.

Inpatient and Postdischarge Rehabilitation Services Provided in the First Year After Spinal Cord Injury: Findings From the SCIRehab Study

In the March edition of the Archives of Physical Medicine and Rehabilitation Dr. Whiteneck and his group from Craig Hospital Engelwood NJ look at the break down in rehabilaition treatments given before and after hospital discharge for Spinal Cord Injury patient. The group found that of the total hours spent on these rehabilitation interventions during the first year after injury, 44% occurred after discharge from inpatient rehabilitation. Participants received 56% of their PT hours after discharge and 52% of their OT hours.
The HandTutor, ArmTutor and LegTutor system is being used by OT's and PT's with SCI patietns both in acute, sub acute, outpatient and home care environments.

Neurotransmitter could improve post-stroke rehabilitation

Neurotransmitter could improve post-stroke rehabilitation

March 10, 2011
Christian Grefkes from the Max Planck Institute for Neurological Research in cooperation with scientists from the Institute of Neurosciences and Medicine of the Forschungszentrum Jülich and the Department of Neurology of the University Hospital of Cologne looked at eleven stroke patients (between 42 and 74 years old) with fine motor deficits. The group carried out a range of motor tasks which involved the determination of maximum grip power and finger-tapping frequency and the execution of pointing movements. The group showed that by reducing the rate of uptake of noradrenaline which in effect prolongs the efficiency of noradrenaline improves motor skills in stroke patient.

Intensive active exercise practice provided by the HandTutor, ArmTutor and LegTutor system has proven effective in improving functional movement ability in post stroke patients.

HandTutor, ArmTutor and LegTutor system provide objective evaluation and follow up

Objective evaluation and follow up combined with customized exercise practice are the fundamentals in physical and occupation therapy treatment of neurological and orthopedic injury and disease and will ensure optimal functional improvement and improve the patients quality of life. Functional assessment including the WOLF MOTOR FUNCTION TEST (WMFT) quantify upper extremity motor ability through timed and functional task assessments however, you will see from this demonstration and scoring protocol that the assessment has a large subjective element http://bit.ly/g3UPrE