Tutor System Increases Confidence and Sense of Achievement for SCI Patients

As reported by Chris Thomas in SCIENCE NETWORK in Western Australia on October 25, 2011

An innovative rehabilitation program has been introduced to Edith Cowan University’s Joondalup campus, after the establishment of a partnership with Spinal Cord Injuries Australia.
“The program aims to give the nervous system a chance to reactivate below the level of injury.”said therapist Kierre Ireland.
Funded by a $320,000 Lotterywest grant, the ‘Walk On Program’ is based at ECU’s Health and Wellness Institute with staff and students trained to develop specific rehabilitation exercises while using state-of-the-art equipment
About 50 people receive a spinal cord injury every year in WA, in addition to the thousands already living with a spinal cord injury.
Twelve people have been chosen to take part in an individually designed exercise program to help maximise their functional recovery.
National Walk On therapist Kierre Ireland says it is a chance for them to get out of their wheelchairs for a two-hour session and complete whole body, intensive and dynamic exercises—no matter what level of function they may have.
“We work all parts of the body, not just the areas unaffected by the injury,” she says.
“This aims to give the nervous system a chance to reactivate below the level of injury.
“All clients complete exercises in different positions, from lying on their side or tummy, to kneeling, standing, crawling and even walking.
“Many clients report the variety of exercises and positions gives them an increased confidence and awareness of their body once again, as well as a sense of achievement and overall positive outlook on their lives.”
Three exercise physiologists completed six weeks of training in activity-based spinal cord injury therapy at the University of Sydney and the Project Walk SCI recovery centre in Carlsbad, California, before the program was launched.
Ms Ireland says the training exposes them to a broad variety of people with different levels and severity of injuries.
“A spinal cord injury is such an individualised injury, meaning there are rarely two people who present with the same level of function and ability,” she says.
“There is no other training in the neurological field that offers such an extended experience and exposure working exclusively with people with spinal cord injuries.”
Physical benefits include an improvement in patients’ ability to transfer from wheelchairs to beds or in and out of cars, being able to wash or feed themselves more independently and an overall improvement in balance and strength that makes it easier for them to pick things up.
“Many of our clients also report gaining a huge psychological improvement with a more positive approach to their lives, increase in self-confidence and a sense of worth,” Ms Ireland says.
The newly developed state of the art Tutor devices have through their powerful evaluation software increased the confidence and sense of achievement of patients suffering from SCI, Brain injury, Parkinson’s disease, MS, stroke, limb surgery and other debilitating issues. The Tutor system (HandTutor, ArmTutor, LegTutor and 3DTutor) are designed to give the patient a functional recovery. The 3DTutor, for example, is a wireless motion feedback device that can be positioned on discrete joints of the head, trunk or upper and lower extremities. This allows for evaluation and treatment of the joint of choice. The 3D unit can be used independently or in conjunction with the other Tutor devices to exercise interjoint movements. The Tutor system can bring a positive approach to the life of the patient.
The HandTutor and its “sisters” is currently being used successfully in leading U.S. and foreign hospitals and clinics. It is designed for adults and children alike and is fully certified by the FDA and CE.

U.S.Rep.Giffords Can Supplement her Therapy With the Tutor System

ASHEVILLE — Since the late 1800s, Asheville has been known nationwide as a rehabilitation haven. So, in a way it should come as no big surprise that U.S. Rep. Gabrielle Giffords is spending the next two weeks here for intensive work with an Asheville therapist.
“It’s something that’s been planned for quite some time — it’s not a last-minute thing,” said Mark Kimble, spokesman for Giffords, D-Ariz. “It’s also just an attempt to have a period of very focused and concentrated therapy with this therapist. It’s part of her continuing recovery in a number of different areas.”
Giffords was shot in the head Jan. 8 at an event in Arizona, surviving an injury to her brain that leaves 88 percent of victims dead. She can understand written and spoken language, but still has some trouble speaking, especially when she’s tired or under stress, Kimble said.
He declined to state who the Asheville therapist is but said the person has been working regularly with Giffords during her nine-month rehabilitation in Houston.
Asheville’s reputation as a rehabilitation center dates to the 19th century when hundreds of tuberculosis patients came here for the rejuvenating mountain air. In the 20th and 21st centuries, much of that reputation has revolved around CarePartners Rehabilitation Hospital, an 80-bed regional center with rehabilitation programs for a numerous illnesses, injuries and conditions.
Opened in 1938, the facility formerly was called Thoms Rehabilitation Hospital and has drawn severely injured patients to the mountains for decades.
CarePartners does not have a patient by the name Gabrielle Giffords, said Tom Adkins, vice president of business development. Merrell Gregory, a spokeswoman at Mission Health, which has an outpatient rehabilitation operation, also said the hospital has no patients by that name.
Like all members of Congress, Giffords is under the security protection of the U.S. Capitol Police. She has no public appearances scheduled here, Kimble said. The therapy will be intensive, though.
If the Asheville rehabilitation center that the congresswoman is receiving physical therapy in includes the Tutor system her progress will be enhanced by it.
The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has 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 massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.
The new medical devices are available for children as well as adults and through the use of telerehabilitation and are FDA and CE certified.

Tutor System Speeds Brain Injury Recovery of Upper As Well As Lower Joints

As announced on PR WEB in October 2011, Encore Path, makers of the Tailwind device for arm rehabilitation for stroke and brain injury survivors announced its invitation to join Astia, the premier global network serving women-led high growth start-ups since 1999.
Encore Path develops rehabilitation devices for stroke and brain injury survivors. Its first product, the Tailwind, was released in 2009. It is clinically proven to help people with moderate to severe paralysis improve their arm function and range of motion. The Tailwind is available in rehabilitation hospitals and therapy centers worldwide, and is also sold to patients who want to use it at home.
The Tailwind was developed by University of Maryland doctors specializing in physical therapy rehabilitation after a decade of scientific research. Clinical studies have shown that the device helps improve arm mobility, function, and range of motion in patients with even severe paralysis.
The Tutor system (HandTutor, ArmTutor, LegTutor, 3DTutor) uses augmented movement feedback, and allows for customizable and motivating exercise practice for all joints (and not just elbow and arm) and allows the training of two associated joints in a functional movment e.g elbow and shoulder. The Tutor system uses augmented feedback to prevent the patient using a compensatory movement pattern to achieve the task.
The Tutor system can also be used for open and closed chain movement practice in the sitting, standing and lying position.
The system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises so as not to become bored with the therapy. 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 used at home via telerehabilitation.

Post Knee Replacement Surgery Involves Use of the LegTutor

Vikki Petersen writing in Health Now October 2011 states that baby boomers are getting older. With increased age comes increased wear and tear on the joints of the body, but the desire to remain active has resulted in more and more surgeons and patients opting for knee replacements than ever before. Unfortunately most patients are told only about how the surgery helps in decreasing pain levels and assists them in getting back to their active lifestyle. Very few are actually told the realities of how important rehab is or how difficult it can be to truly regain full range of motion or strength in the replaced knee. As a physical therapist I too often see patients coming in for a post surgery appointment with absolutely no idea of what it will take to restore their knee back to the flexibility and strength they desire.
If the post knee surgery rehabilitation involves the LegTutor™ the chances of returning full range of motion are increased manyfold.
The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the lower extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The LegTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The LegTutor™ allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The LegTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

Neuroplasticity and its Applications for Rehabilitation With the Tutor System

Posted January 13, 2011

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Neuroplasticity and its applications for rehabilitation using the Tutor system:
In the January edition of theAmerican Journal of Therapeutics Symposium: Stroke Management, Dr. Young and Dr. Tolentino of Rush University report on neuroplasticityand its applications for rehabilitationhttp://bit.ly/gN0oUW . The report describes the various studies on neuro plasticity and the variety of interventions now available.
The HandTutor system with its sister devices (ArmTutor, LegTutor and 3DTutor) uses the proven concept of active intensive exercise practice. However the power of the dedicated rehabilitation software is the fact the exercise task provides the patient with real time instructions on how to move their hand, arm, fingers and other joints of the body. The tasks can be customized so that the difficulty level will exercise the patients exact movement dysfunction. In addition augmented feedback is provided on the result of the patient’s movement and on the patients movement performance this motivates and stimulate patients to continue task practice.
www.HandTutor.com

LegTutor Enhances Range of Motion for Knee Replacement Patients

Pazit Levinger etal conducted a study published in Springer Link in October 2011.
The purpose of the study was to determine why knee pain and disability persists following knee replacement surgery which may place patients at increased risk of falls. This study investigated the falls risk and the occurrence of falls of people with knee osteoarthritis (OA) before and at 12 months following knee replacement surgery.
The method used in the study was:
Thirty-five patients with knee OA were tested prior to undergoing knee replacement surgery and at 12 months following surgery using the short form Physiological Profile Assessment, which incorporates tests of vision, lower limb proprioception, knee extension strength, reaction time and postural sway. Physical activity, number of falls, fear of falling, pain, disability and health-related quality of life were also assessed.
The results showed that there were no significant differences found between the number of falls pre- and post-surgery (n.s.), with 48.5 and 40% reporting at least one fall in the 12 months before and following the surgery, respectively. Improvements in knee strength, reaction time and fear of falling were evident following surgery, with no improvement in lower limb proprioception. Self-reported pain, function and stiffness were significantly improved, but health-related quality of life deteriorated following the surgery.
The conclusion reached was that the number of falls experienced following knee replacement surgery remained relatively high, which may be attributed to the persistence of impaired lower limb proprioception. Although knee replacement surgery improves function and alleviates pain, people who undergo this procedure may need to engage in rehabilitation following the surgery to reduce the risk of falling.
The LegTutor has shown remarkable success in post knee replacement surgery. The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™ allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the lower extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The LegTutor™ rehabilitation concept, which includes the HandTutor, ArmTutor and 3DTutor, is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The LegTutor™ allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
The LegTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification and is available for adults and children.

Tutor System Available by Telerehabilitation

As posted on 10/21/2011 by the University of California System: University of California, Irvine:
To regain movement and mobility after a stroke, stroke patients undergo intensive rehabilitative therapy with rehabilitation nurses and physical therapists. These rehabilitation sessions occur on an outpatient basis and typically average three days a week for several hours a day. Such sessions are expensive since it involves one-on-one therapy sessions between the patient and the therapist. It also may be inconvenient for a stroke patient to travel to the rehabilitation sessions, particularly given post-stroke disabilities or regional disparities in health resources. Furthermore, studies have shown that a larger dose of rehabilitation therapy can be beneficial for the stroke patient. A physician at the University of California, Irvine has developed a new telerehabilitation system including new software that may be used or supplemented in stroke patients’ rehabilitation therapy programs. This telerehabilitation system may be used at home and would cost significantly less than physical therapy and eliminate the patient’s commute to a therapy session.
Stroke patients as well as those who have had a TBI or Spinal cord injury can, when they are sufficiently recovered, avail themselves of the Tutor system through the use of telerehabilitation.
The HandTutor, ArmTutor, LegTutor and 3DTutor 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 massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation and objective follow up. The Tutors are FDA and CE certified.The new medical devices are available for children as well as adults.

Tutor System Can Augment Proposed Medication

The following was published in The Sacramento Bee on Friday, Oct. 21, 2011:
Avanir Pharmaceuticals, Inc. today announced that pseudobulbar affect (PBA) prevalence data from stroke survivors will be highlighted at the 88th Annual Meeting of the American Congress of Rehabilitation Medicine/American Society for Neurorehabilitation Medicine in Atlanta, GA.
Following are details about the data presentation at ACRM/ASNR Progress in Rehabilitation Research:
Title: Pseudobulbar Affect in Stroke: A National Stroke Association SurveyProgram Number: 0025 Presentation Date/Time: Thursday, October 13, 2011 5:00-7:00 p.m. EST & Friday October 14, 2011 4:30-6:45 p.m. EST
What is PBA?
Patients suffering from existing neurological disease or brain injury may also suffer the added burden of pseudobulbar affect, or PBA. PBA occurs secondary to a variety of otherwise unrelated neurological conditions, and is characterized by involuntary, sudden, and frequent episodes of crying and/or laughing. PBA episodes typically occur out of proportion or incongruent to the patient’s underlying emotional state. PBA outbursts result from a “short circuit” in the brain caused by another neurologic condition-such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), stroke, or traumatic brain injury. PBA can have a debilitating impact on the lives of patients, caregivers and loved ones.
The dose and timing of Avanir’s proposed medication to counteract PBA can augment functional gain of physiotherapy. The Tutor system has been effective as a physical therapist’s tool for patients recovering from brain and spinal cord injury, MS, ALS and other debilitating diseases.
These innovative devices, known as the HandTutor, ArmTutor, LegTutor and 3DTutor, implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.

Occupational Therapists Can Boost their Success with the Tutor System

Rebekah Polley writing in the Central Queensland News on 21st October 2011 about Roslyn Core who is passionate about her work as an occupational therapist.
For occupational therapist Roslyn Core, her job is about the individual moments.
It is those individual moments that make Roslyn passionate about her job as next week marks OT Week where occupational therapists across Australia are celebrated for the work they do.
Roslyn works for Education Queensland and her role involves helping children participate in everyday activities at school and in the community, and achieve developmental milestones such as fine motor skills and hand-eye co-ordination.
“It’s hands on, challenging and varying,” Roslyn said of her job.
“When you see kids make those milestones, it’s very rewarding.
“So many of the children surprise you every day with what they achieve.”
Roslyn has been an occupational therapist for nearly four years and became interested in the profession after her cousin studied the course at university and enjoyed it.
“I fell into it more than chose it,” she said with a laugh.
“I enjoyed the first year and kept doing it.
“There is a huge variety of things you can do with one degree.”
Roslyn studied at James Cook University in Townsville and after working in Roma, got transferred back home to Emerald.
“Emerald is home as I grew up here,” she said.
“I love the community and the people. I prefer to live in country towns.”
Roslyn said she meets some “amazing people” through her job and is taking her skills overseas for a couple of years.
“I want to do something similar overseas and come back and continue my work,” she said.
OT Week is also about spreading awareness about the work occupational therapists do and Roslyn encouraged anyone interested in the profession to find out more.
“If you have a passion for helping other people then definitely do it,” she said.
“It’s an amazing job.”
Occupational therapists using the Tutor system for rehabilitative work find their work much easier to perform.
The Tutor system (HandTutor, ArmTutor, LegTutor, 3DTutor) has shown much success in rehabilitation of joint movement. The newly developed Tutors consist of ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients to be used by occupational therapists and physiotherapists 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 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 occupational 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.

Rehabilitation Facilities Using Tutor System Amongst the Best

BOSTON, Oct. 18, 2011 /PRNewswire via COMTEX/ — A life-altering event, followed by a miraculous recovery. This is the story of Gabrielle Giffords, the U.S. House of Representatives member who recovered from a near-fatal gunshot head wound. Most Americans will never face a similar fate, however, other medical conditions – including stroke, brain and spinal cord injury, neurological disorders (like Parkinson’s disease and multiple sclerosis), complex orthopedic issues, and amputation – will require intensive rehabilitative therapy. For those affected, the question becomes, Will I receive the same quality of care as Gabrielle Giffords?
When preparing to leave a hospital’s Intensive Care Unit (ICU), decisions are needed regarding care. Here’s what patients need to know to choose the best rehab facility.
Freedom of Choice
“Although they may not know it, patients have considerable say about where they go following discharge from ICUs,” says Deniz Ozel, M.D., medical director, New England Rehabilitation Hospital, a world class rehabilitative hospital located in Woburn, Massachusetts. “Working with their case managers, they can become empowered and affect the decision-making process.”
Arthur Williams, M.D., medical director at Braintree Rehabilitation Hospital, another leading rehabilitative hospital in Braintree, Massachusetts, concurs. “Case managers are uniquely qualified to understand a patient’s diagnosis, insurance coverage, and make recommendations for a discharge plan,” says Williams. “It’s their job to find the right balance between medical care and rehabilitative therapy to help patients reach their goals and objectives.”
Typically, options include:
Skilled nursing facilities – offering less intensive rehabilitation therapy with management of non-complex medical issues;
Long term acute hospitals – offering management of multiple system failure with less focus on rehabilitation; and
Inpatient rehabilitative facilities – offering intensive rehabilitation services, with management of complex medical issues.
Inpatient rehabilitative facilities, dedicated to short-term rehabilitation, are ideal for those who have suffered a significant medical event, yet well enough to benefit from intensive therapy.
Patients with no prior rehab experience should network for recommendations. The case manager also should be able to refer local providers.
Top Criteria
With referrals in hand, here’s what to ask:
1. How will the facility help me reach my goals? Does it have success treating my type of injury? Look for a comprehensive plan of care. Ask about specialty programs for your condition.
2. How much therapy will I receive? Intensive programs offer a minimum of three hours of therapy a day, five days a week.
3. Who will provide my care? How often will I see a doctor or specialist? Ask who will comprise your team and if physician oversight is provided 24/7.
4. What technology is available that will benefit me? New devices incorporating functional electrical stimulation and robotics offer a track record of success.
5. How does the facility compare against the competition? Ask about accreditations like those from The Joint Commission, use of Functional Independence Measure (FIM) scores, and patient satisfaction surveys.
6. Check if the facility can improve functional outcomes in physical rehabilitation with the best and latest equipment to treat injured limbs and joints. If the Tutor system is used the center may be one of the best to choose from.
The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy for interactive rehabilitation exercise. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.

ArmTutor Compliments Stroke Therapy

Hema Vijay writing in THE HINDU on October 18, 2011 describes what Dr. Preeti Raghavan is involved in.
Dr. Raghavan holds a beacon of hope for those who have been incapacitated by stroke. Her study of memory and movement in the field of neuroscience has aided many to lead near normal lives
She teaches the brain to make new connections; connections which could help stroke victims regain the ability to move a finger, hand, leg or arm. Preeti Raghavan, MD, and the ‘brain’ behind the Motor Recovery Research Laboratory at the Rusk Institute of Rehabilitation Medicine, the premier rehabilitation hospital in New York State, believes in the awesome potential of the human body.
For many years now, Dr. Raghavan has been reverse engineering the neural pathway of movements. “Even if a part of the brain has been affected by stroke, the person can still relearn the movement — through an alternate pathway in the brain,” she says. Dr. Raghavan studied medicine at the Annamalai University and later at New York before going on to make path-breaking findings.
It all began when she started studying how people perform movements. Think of this; we never consciously calculate the amount of pressure or the extent of the turn we need to give our fingers to hold a spoon, open a tap or shake hands. “But actually, even a simple movement requires complex planning, which we learn and store in our memories for reuse,” Dr. Raghavan explains.
Four years ago, Dr. Raghavan was studying movement in stroke patients by using a simple grip device with sensors that measured forces produced by fingers when a movement is executed. “These people couldn’t work out the force required to grasp and lift the object. Their old memories had been erased by the stroke, and new memories were not allowed to be formed, because of the damage to the neurological tissue,” she recounts. It was then that Dr. Raghavan made the amazing discovery that, if the same people lift the object with the intact hand and then repeat the movement with the affected hand, the affected hand is able to learn to perform the movement! “The idea is to use alternate connections. Amazingly, our brains have developed many redundant neural pathways for the same function. We utilise those preserved parts of the brain to revoke the lost function,” Dr. Raghavan adds.
For instance, one of Dr. Raghavan’s patients was a young musician who had had a successful bone marrow treatment for cancer, and later had a stroke. He recovered from it enough to run marathons, but still couldn’t manage movements such as holding a toothbrush, or tying shoe laces. Now, with Dr. Raghavan’s strategies, this young man is ‘learning’ to do it!
“Advances in research such as in Dr. Raghavan’s lab are increasing the understanding of cerebral physiology and function needed to build the necessary framework for better treatments specific to individuals with unique injuries. The work in Dr. Raghavan’s lab is a great example of translating basic sciences into clinical practice — and is creating excitement in neuroscience advances,” says Steven Flanagan, MD, clinical professor and chairman, Department of Rehabilitation Medicine and medical director, Rusk Institute at NYU Langone Medical Center.
Dr. Raghavan also zeroed in on musicians as subjects of study, because, musicians happen to be among the most dexterous users of their limbs. This is how she discovered that professional pianists who activate their upper back muscles while playing the piano tend not to suffer from overuse strain or injuries, compared to those who use just their fingers and arms. “It is a popular misconception that muscles are just tissues for execution of action. But muscles are also important for our kinesthetic sense. That is how expert musicians know how to apply just enough force,” she remarks. She uses such insights to help stroke victims and others in regaining optimum use of their limbs. Dr. Raghavan is also studying how listening to music and patterning rehabilitation exercises alongside musical rhythms may enhance the speed of recovery tremendously. “Rhythm assists movement because, we move in space and time”, she says.
Working with her team of doctors, engineers, statisticians, physical and occupational therapists, Dr. Raghavan is helping stroke victims and others get movement back into their lives. Finally, some advice for all of us: “We are moving all day long. The hierarchy of movement has to be efficient; otherwise it can lead to trouble.”
In addition to Dr. Raghavan’s program the ArmTutor is a compliment to restoring normal movement to the patient’s upper extremities.
The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The ArmTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The ArmTutor™ allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. 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.
The ArmTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

ArmTutor Can Speed Recovery of Jason Blake’s Arm

Jerry Petrolli writing for Boomakers Inc. on 17 October 2011 shares that Jason Blake, Anaheim Ducks left wing, will not be playing for three months due to tendon damage in his left forearm, which was caused by a severe cut.
On Saturday, the Ducks announced that the player will receive surgery next week to repair his arm.
Blake suffered the injury midway through the third period of Anaheim’s 1-0 win Friday night over San Jose, and white label sites saw that after the player fell down while he was trying to play the puck out of a faceoff he was accidentally cut just above his left wrist by Brent Burns, Sharks defenseman.
“This was an unfortunate, freak accident, but we are pleased to hear that Jason is expected to make a full and complete recovery,” Ducks general manager Bob Murray said. “He’s a real character person and teammate, and we look forward to having him back in our lineup when he’s ready.”
The player spent the night at UC Irvine Medical Center. On Monday, Dr. David Hay will perform corrective surgery on Blake’s tendons at Los Angeles’ Kerlan-Jobe Clinic, and white label sites hope that the player makes a swift recovery.
Blake, 38-years-old, and very well known with white label sites, enters his third season with the Ducks after he recorded last season 16 goals and 16 assists as a rough two-way forward. He skates on Anaheim’s second line with Teemu Selanne and Saku Koivu.
Sports labels know that Blake is a durable professional, playing every season since 2000-2001 in at least 75 games.
In October 2007, the Minnesota native was diagnosed with cancer, but in the ensuing season he played every game with Toronto even though he lost 10 pounds while going through treatment. Blake was awarded the Masterton Trophy for perseverance, sportsmanship and dedication to the sport. The newly developed ArmTutor will be able to afford Blake improved functional outcomes in physical rehabilitation.
The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for interactive rehabilitation exercise and a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The ArmTutor™ rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.
The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.
The ArmTutor™ allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. 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.
The ArmTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.
..

Cognitive Rehabilitation and the Tutor System Work Together

John M. Grohol, Psy.D. reviewed the following information on October 13, 2011 for PSYCH CENTRAL
Solid evidence is lacking thus far that specific goal-oriented treatments are effective for traumatic brain injury, or TBI, though results are promising, according to a government report.
Each year, it is estimated that 1.7 million people in the United States sustain a TBI. From 2000 to 2010, the number of military service members diagnosed with TBI nearly tripled from just under 11,000 to more than 30,700.
Traumatic brain injury results from a bump or blow to the head, or from external forces that cause the brain to move within the head, such as whiplash or exposure to blasts. It can cause cognitive, physical, and/or psychosocial problems.
One form of treatment for TBI is cognitive rehabilitation therapy (CRT), a goal-oriented approach to help patients increase their ability to process and interpret information. CRT involves a variety of treatments provided by health professionals in a wide range of fields. When the TBI causes joint movement impairment the Tutor system has become invaluable.
TBI is so prevalent in modern combat that it is considered the “signature wound” of the conflicts in Iraq and Afghanistan. The U.S. Department of Defense thus asked the Institute of Medicine (IOM), the health division of the National Academy of Sciences, to conduct a study to determine the effectiveness of cognitive rehabilitation therapy for treatment of TBI.
“Survivors of traumatic brain injury may face long-term challenges in physical as well as emotional rehabilitation and reintegration to everyday life. They need an effective health care infrastructure and evidence-based treatment and rehabilitation policies to care for and cope with their impairments,” said Dr. Ira Shoulson, the head of the IOM committee that studied the problem and a neurologist at Georgetown University.
The goal of cognitive rehabilitation therapy (CRT) is to help an individual with a brain injury enhance his or her ability to move through daily life by recovering or compensating for damaged cognitive or physical functions. A restorative approach helps the patient reestablish cognitive function, while compensatory approaches help the individual to adapt to an ongoing impairment.
When the disability is specifically physical the HandTutor, ArmTutor, LegTutor and 3DTutor have played an important role in interactive rehabilitation exercises.
The Tutors have become a key system in neuromuscular rehabilitation and physical therapy improving functional outcomes for upper and lower limb disabilities due to TBI. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.

Tutor System Can Help Maintain Current Strength in Arthritis Sufferers

FAMILY PRACTICE NEWS Oct. 11, 2011 featured this article by M. Alexander Otto
When knee replacement worsens Arthritis in other joints the newly developed Tutor System can help maintain the current strength of the affected joints.
It’s not unusual for total knee replacement patients to have arthritis in other joints, and it negatively impacts surgery outcomes, Toronto researchers have found.
In their study, 420 of 494 knee replacement patients (85%) reported problems in at least one other joint. Those with foot or ankle arthritis had a significantly reduced chance of achieving an MCID (Minimally Clinically Important Difference) on postoperativeWOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain and function scores (odds ratio pain 0.32, 95% confidence interval 0.185-0.544; OR function 0.53, 95% CI 0.303, 0.940).
Patients who reported neck problems also had reduced odds of achieving an MCID on physical function WOMAC scores (OR 0.37, 95% CI 0.183, 0.726).
“It’s not surprising that ankles and feet [were] significant. [They] impact activities for which lower-extremity joints are involved. How the upper extremities are associated here, in particular the neck, is unclear,” said lead investigator Anthony Perruccio, Ph.D., an epidemiologist and research scientist at the Toronto Western Research Institute.
Because patients with neck problems also saw less improvement in fatigue, anxiety, depression, and pain, there may also be a mental health component, he said.
Whatever the case, the lesson is to treat the whole patient, not just the knee. Referrals to other types of providers are appropriate, including physiotherapists and mental health counselors as needed, said Dr. Perruccio.
“There’s more than just the one joint that’s involved here. Outcomes could be improved if a more holistic approach to osteoarthritis management were considered,” he said.
All 494 patients had primary, unilateral knee replacements secondary to osteoarthritis. Their mean age was 65, 65% were women, and almost half were obese.
The patients filled out several surveys before their operations, including WOMAC and other pain and function scales plus the Profile of Mood States (POMS) fatigue scale, the Knee injury and Osteoarthritis Outcome Score (KOOS) sports and recreation scale, and the Hospital Anxiety and Depression Scale (HADS). They also pointed out on a homunculus diagram which joints were causing trouble.
Almost half (46%) reported pain on most days in four or more joints in addition to their operative knee. The nonoperative knee was a problem for 57%, elbows/wrists/hands were problematic for 49%, ankles/feet for 36%, the back for 31%, shoulders for 29%, hips for 25%, and neck for 22%. Just 15% said only their operative knee was symptomatic.
A year after their operation, patients took the surveys again. Those with back problems tended to see less improvement in fatigue at 1 year. Those with ankle or foot arthritis – in addition to diminished returns on pain and function – also saw less improvement than others in depression and sports and recreation scores.
The congress was sponsored by the Osteoarthritis Research Society International. Dr. Perruccio said he had no relevant financial disclosures. The work was funded by the Canadian Institutes of Health Research.
Major Finding: About 46% of 494 primary total knee replacement candidates reported pain or other problems in four or more other joints.
The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, allows patients to do intensive exercise practice that is customized to their movement ability and has 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 massed controlled exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation. The new medical devices are available for children as well as adults and through the use of telerehabilitation and are FDA and CE certified.

SCI Patients Improve Their Chances with the Tutor System

THE NATION featured this report by Carol Aloysius about SCI difficulties in Sri Lanka.

Spinal cord injuries are on a dramatic rise in Sri Lanka caused by the increase in construction industry work, road accidents, domestic and industrial accidents as well as war injuries. Every year around 1500 – 2400 patients are admitted to hospitals with Spinal Cord Injuries (SCI) and every four hours, one person dies without proper treatments. This year alone, in the first three months, there were 175 victims of SCI admitted to the NHS, orthopedic surgeons said at a media seminar held at the Health Education Bureau on Thursday. The seminar was to discuss the forthcoming 10th Asian Spinal cord Network ( ASCON) on total care for patients with SCI. Over 80 million people suffer from Spinal Cord Injury every year globally according to the WHO.

“Our hospitals are still not properly equipped to handle such patients to ensure the best outcomes. Our objective is to develop a regional network and set up a ward with special beds in all hospitals island wide for SCI patients in the near future,” Dr. Anil Dissanayake, Director of Youth, Elderly & Disabled said. At present, the country’s only specialized SCI unit at Ragama. SCI patients are still waiting for approval to build a badly needed residential home for those who cannot return to their own homes due to lack of facilities such as special toilets, beds etc, a spokesperson from the hospital said.

Dr. Narendra Pinto, Consultant Orthopedic & Trauma Surgeon NHSL noted that trauma from an SCI was the leading cause for hospital admissions with the victims being mostly young males between 25- 45 years at the peak of their productivity.” Injuries could be minor, major or fatal and caused by occupational, home environment, war in juries, assaults, recreational activities or sports. “More injuries occur during vacations and on trips, as well as during the festive seasons in April and December. Falling from heights such as trees, construction buildings, roofs, or slipping on the floor or diving into shallow water could injure spine. Once the spine is injured, it cannot be cured completely . We can only minimise the damage and optimise rehabilitation to avoid further complications”, he informed.

Emphasising his colleague, Dr. G.L Punchihewa President, Sri Lanka Orthopedic Association said, “There are no miracle drugs for spine injuries. If someone meets with a sudden accident, care should be taken to avoid a second accident while transporting that patient. Call 110 for help and a rescue team of trained personnel will be at the accident site within 10 minutes anywhere in Colombo.”

Of those admitted to hospital, he noted, over 55% were cervical spine injuries; 15% injuries thoracic spine injuries and 15% lumboscaral spine injuries.” These injuries could result in fracture, dislocation or nerve injury which may result in permanent disability depending on the level and severity of the injury.

Dr. Lilani Panangala, Consultant at the Ragama Hospital, said that the Ragama Rehabilitation Hospital was the only specialised SCI unit in Sri Lanka with institutional rehabilitation capacity for 150 persons per year, and beds available for 120 patients. At least 1350 patients with SCI do not receive p roper rehabilitation and over 75% percent die within 18 – 24 hours from complications like pressure, sores etc, she informed. She also appealed to authorities to expedite approval for building for the badly needed residential centre to have proper care facilities for SCI patients who are unable to go back home.

The HandTutor, ArmTutor, LegTutor and 3DTutor are devices that are FDA and CE certified and are being used in leading U.S. and foreign hospitals.

These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability.

They have had success in improving movement of the hand, wrist, elbow, knee, ankle, foot and other joints of the body following Spinal Cord and other traumatic injuries. The devices have been effective for post stroke victims as well as for those suffering from Cerebral Palsy, brain injuries, Apraxia, MS, Parkinsons and other movement disabilities. Intensive active exercise can reduce the rate of deterioration and this is what the ”Tutor” devices provide.

The system is also used in physical therapy clinics as well as the patient’s home with tele rehabilitation. The ”Tutors” are suitable for adults and children.

Tutors Effective in Stroke Rehabilitation

BETSY BATES writing in Internal Medicine News Digital Network from SAN DIEGO, California declares that it’s a familiar sound to neurologists, who have grown accustomed to watching the clock as they hurry to get tissue plasminogen activator on board in ischemic stroke patients.
If Dr. Steven Cramer proves correct, a second timer may soon be ticking, this one measuring in days or weeks a limited “golden” period in which combined restorative therapies and rehabilitation efforts should be initiated to achieve maximum effect.
“Therapeutic windows open and close,” stressed the University of California, Irvine (UCI), professor of neurology during a presentation at the annual meeting of the American Neurological Association.
Comparing brain plasticity after stroke to that seen in early development, Dr. Cramer emphasized the need for pairing restorative therapeutic targets with behavioral conditioning, and doing it all at the optimal time.
“It takes a lot of practice to make the brain better.”
Nature provides its own best rationale, propelling “most of the action” in spontaneous recovery within a month post-stroke, he said.
In animal models, brain response to a unilateral lesion is rapid and intense, Dr. Cramer explained.
“We see inflammation and a wealth of growth events that look very much like a developing brain. It’s an excitable brain,” ushering in building blocks for repair and regrowth of cells, dendrites, and synapses.
“Some people look at this and say these are molecular underpinnings of spontaneous recovery. Some people look at this and say, these are therapeutic targets, because if these are the components that are the backbone of spontaneous repair, amplifying these sorts of processes could lead to enhanced outcomes compared to the natural processes.”
Quickly administered stand-alone treatments have indeed been shown to mimic and expand on this natural boost to early recovery, but Dr. Cramer predicted far more will happen if active rehabilitation is added to the mix.
“When the brain is fertile to undergo repair, whatever substance you give has maximum effect if it is paired with the right kind of experience,” Dr. Cramer said.
“If you sprinkle your best restorative pixie dust on the brain, you’re not going to get the same effect as if you pair it with some kind of behavioral shaping.”
Stroke disability is one of many events or diseases that the Tutor system can be effective in restoring joint and limb movement. The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.