Tutor System Designed for Children Who Suffer from TBI

Writing for the Amarillo Globe News LANCE LAHNERT on October 13, 2011 reports that the fight for Vega junior football player Luis Morales to regain his ability to walk took flight Thursday.
Morales was flown Thursday from Amarillo to a Sacramento, Calif., hospital known for world-class research on spinal cord injuries so he can continue rehab for an injury suffered during a junior varsity football game Sept. 29 in Wheeler.
Morales, a running back, crashed into the Wheeler home stands at the end of a run.
The head-first crash left him without movement of his legs and arms, said Vega head football coach Phillip Wiggins.
“He was trying to regain his balance as he went out of bounds and ran head first into the home bleachers,” Wiggins said.
“The helmet did its job. But the helmet is not made to protect the neck.”
Morales spent 14 days at Northwest Texas Hospital in Amarillo before taking Thursday’s flight to Shriners Hospital for Children — Northern California in Sacramento.
“I want to be respectful to the family in what I say,” Wiggins said, “but as I understand it, Luis did regain some movement in an arm before leaving for Sacramento. What great news. And what a great kid. Our prayers are with him and his family.”
The most recent information from the American Association of Neurological Surgeons shows 10 to 15 percent of high school athletes who participate in a contact sport suffer a concussion.
Statistics from the 2009 football season show nine brain injuries that resulted in incomplete recovery, and all nine were at the high school level, the association reported.
Children are included in the design of the newly developed Tutor System used in post TBI physiotherapy. There have been many advances in brain recovery and rehabilitation and one of the most effective methods to regain normal usage of the patient’s limbs and joints is the HandTutor, ArmTutor, LegTutor and 3DTutor.The Tutors allow the patient to do intensive exercise practice that is customized to their movement ability.
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. They are fully certified by the FDA and CE.

How the TUTORS Help TBI Victims

An article by SUSAN K. LIVIO for North Jersey.com on October 12, 2011 tells how nearly one in four injured service members returning from Iraq and Afghanistan has suffered a traumatic brain injury — a grim diagnosis that may force them to relearn the most basic of skills — walking, talking and meeting daily challenges of life.
Ron Sharp, 61, a Vietnam veteran, is the first participant in a therapy program for New Jersey vets with traumatic brain injuries at Bancroft NeuroHealth.
Bancroft NeuroHealth’s 20 years of experience in dealing with such injuries has allowed it to land the only contract in New Jersey from the U.S. Department of Veterans Affairs to serve moderately and severely brain-injured members of the armed services.
Bancroft, based in Haddonfield, is one of 21 nationally accredited agencies that won a contract in June. The three-year, $23.5 million Assisted Living-Traumatic Brain Injury pilot program is aimed at helping veterans cope with the limitations of their conditions — and to regain independence wherever possible.
“Brain injury is … a lifelong condition,” said Cynthia Boyer, senior clinical director for Bancroft’s brain-injury programs. “It’s not like breaking your leg and you heal and get better. Life strategies may have to change.”
Traumatic brain injury is the “signature wound” among those serving in Iraq and Afghanistan, accounting for 22 percent of all casualties and 59 percent of blast-related injuries, said Kristine Yaffe, a psychiatry professor at the University of California, San Francisco. Yaffe is also director of the memory disorders program at the San Francisco VA Medical Center.
According to the U.S. Department of Defense, 161,025 service members were diagnosed with a traumatic brain injury from 2000 to 2009.
When TBI occurs and recovery is progressing the Tutor system (HandTutor, ArmTutor, LegTutor, 3DTutor) has shown much success in rehabilitation of joint movement. 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 will help to prevent the development of compensatory movement patterns. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. In addition the therapist can objectively and quantitatively evaluate and report on the treatment progress. The rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows the patient to better perform everyday functional tasks to improve their quality of life. The Tutor system is FDA and CE certified. Research has shown the efficacy of the Tutor system. See http://www.ncbi.nlm.nih.gov/pubmed/20740477

Tutor System One of the Best Techniques for TBI Recovery

The Washington Post’s David Brown reported on Tuesday, October 11 that there might be really good ways to restore brain-damaged people — especially the young wounded of the Iraq and Afghanistan wars — to a healthy, if not entirely normal, state. But it’s difficult to say with certainty what those techniques are. On the other hand one of many techniques to improve functional outcomes in physical rehabilitation for TBI patients is the Tutor system.
That’s the conclusion of a scientific review of “cognitive rehabilitation therapy” performed by the Institute of Medicine at the request of the Defense Department.
This less-than-satisfying message from a 250-page report prepared by 14 experts is a testament to how difficult it is to study treatments for problems such as clouded thinking, inarticulate speaking, poor planning, bad mood, unemployability and family conflict. It’s not as simple as determining whether a drug for hypertension reduces blood pressure.
“It doesn’t mean beneficial therapies don’t exist. It just means that at this point in time it’s hard to ascertain them,” said Ira Shoulson, a neurologist at Georgetown University who headed the Institute of Medicine panel.
“There are certainly deficiencies in the evidence about what works,” he added. “But there are also some glimpses of benefit. I’m fairly upbeat about this.”
Nevertheless, the report released Tuesday is unlikely to answer questions that both patients and medical practitioners have about optimal treatment of blast injuries suffered on the battlefield.
As of late last year, 196,000 military service men and women had been diagnosed with traumatic brain injury (TBI) since 2000. Early in the current wars, about 65 percent of cases were mild, which the military calls concussions. The rest were in the “moderate to severe” category, characterized by loss of consciousness for more than 30 minutes and mental confusion or memory loss lasting more than a day.
Although the number of combat brain injuries rose steadily over the past decade (peaking at 29,000 in 2009), severity has fallen. Today, about 80 percent are mild, with full recovery expected in most cases.
Although the wars, and to a lesser extent football injuries, have put traumatic brain injury on the public agenda, the problem isn’t new. Each year about 1.7 million Americans suffer a brain injury requiring medical treatment. About 52,000 die and 125,000 have long-term impairments.
Those disabilities include problems paying attention, following conversation, communicating clearly, reading, remembering, feeling oriented in space, tracking objects with the eyes, and planning and solving problems. Mood disorders, family problems and difficulties holding a job are also common.
Brain-injury rehabilitation is a murky subject, and evaluating what works is an unusually hard task.
That’s because patients vary in their pre-wounded intelligence and emotional state, as well as the severity of their injuries. Further, “rehabilitation” consists of many activities, including speech therapy, occupational therapy, physical therapy, psychological counseling and social work. There are also many ways of measuring success, from neuropsychological tests to asking the patient whether things are better.
The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, is an interactive rehabilitation exercise.
The newly developed Tutor devices 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.

Injury Prone Jordan Wynn Needs the ArmTutor

LYA WODRASKA writing in The Salt Lake Tribune on October 11, 2011 reports that any hope that quarterback Jordan Wynn could return this year ended Monday when the Utah Utes announced Wynn, who injured his left shoulder in the Utes’ 31-14 loss to Washington, must have surgery to repair the damage.
It will be the second surgery in less than a year for the junior, who had surgery in December on his right shoulder.
Wynn finishes the year 66-for-116 for 727 yards and six touchdowns with two interceptions. Wynn often struggled throwing long due to lingering effects from his December surgery and now faces another long recovery following the repair to his nonthrowing arm.
“Obviously this is disappointing news for Jordan and the entire team,” Utah coach Kyle Whittingham said. “Jordan worked incredibly hard to come back from his shoulder surgery last winter and we are confident he will take the same approach with his rehab this time around. The good news is that he is eligible for a redshirt season.”
Backup quarterback Jon Hays will start for the Utes the remainder of the season. A transfer from Butte College, Hays was 18-for-30 for 199 yards and a touchdown against Arizona State Saturday in the Utes’ 35-14 loss.
Hays also threw three interceptions in what was his first start, but said Monday he can improve.
“I have to work on the little things and take better care of the ball,” he said. “I did OK, but I’m definitely not satisfied and took some chances I shouldn’t have.”
The Utes modified the offense to fit Hays’ style and the quarterback said he is settling into his role.
“I feel comfortable with the offense and I’m going to keep getting more comfortable as the weeks go on,” he said. “I’m just going to have to get back out there.”
Hays said Wynn has helped him make the adjustment from backup to starter. Now being a player-coach is the main role Wynn will have the rest of the season.
The shoulder injury is a big setback for the quarterback from Oceanside, Calif., who said he wanted to prove he was of the same caliber as the top-rated quarterbacks in the Pac-12.
He showed that kind of promise as a freshman when he replaced Terrance Cain as the starter and rallied the Utes to a win over Wyoming. He followed that showing by having the best starting debut ever for a Utah freshman quarterback, passing for 297 yards and two touchdowns in a 45-14 win over New Mexico.
He capped the year off by earning MVP honors in the Poinsettia Bowl as he led the Utes to a win over Cal.
Unfortunately, his career has been hampered by injuries ever since. He missed two games last year with a thumb injury and played the last few games despite a shoulder injury. However, a hit he took against BYU damaged his throwing shoulder enough that he had shoulder surgery on Dec. 13 and sat out the Las Vegas Bowl loss to Boise State.
Keeping him healthy this year was the Utes’ top priority for their offense.
The ArmTutor can assist Mr. Wynn in regaining full use of his shoulder.
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 with its sister devices (HandTutor, LegTutor and 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.
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Biofeedback After a Stroke and the Use of the Tutor System

LIVESTRONG.COM features this article By Tamasin Wedgwood on Oct 5, 2011 The American Stroke Association likens biofeedback to looking in a mirror to check that one is moving in the correct way. Electrodes measure bodily functions – heart rate, muscle movements or blood pressure – and the information is fed back to the patient. Biofeedback is mainly used in stress-related conditions, demonstrating to patients how relaxation improves symptoms. Its effectiveness after a stroke is disputed and still experimental. However, there is growing interest in using biofeedback in stroke rehabilitation therapy.
Biofeedback takes three forms. Thermal biofeedback measures skin temperature. Neurofeedback measures brain activity and electromyography (EMG) measures muscle activity. Measurements captured by the electrodes are displayed on a monitor. A therapist explains this data to the patient. Initially by trial and error, the patient alters his behavior and the resultant readings are displayed on a screen. These changing readings provide visible evidence of how a patient’s reactions are influencing his symptoms or improving his bodily functions. In time patients learn to control their symptoms without needing the monitor.
Biofeedback is a drug-free therapy. It is a treatment that gives patients a sense of control over their own illness and recovery. Visible evidence of improvement is a psychological encouragement. It has the most value in conditions where there is a psychological element rather than a purely physical cause.
Biofeedback has demonstrable value in reducing high blood pressure. Muscle function data is potentially useful since stroke patients have frequently lost the use – or have reduced use – of a limb. EMG feedback is used with physiotherapy to help patients reeducate their limbs in movement. It can also help teach patients how to grip and then release objects in a stroke-impaired hand. A 2009 article in the Biofeedback Matters newsletter suggested that while physiotherapy alone could improve grip, teaching stroke patients to relax and release objects was harder. Stroke patients’ brains and muscles can be overactive, causing continued muscle tension when a patient desires to release an object. Biofeedback could help because of its proven benefit in teaching relaxation. According to Dr. Richard Harvey of Chicago’s Rehabilitation Institute, biofeedback usefully teaches improved motor control, but it cannot help patients learn new functional tasks.
Early research was promising. A 1989 study at the Stroke Research Unit, Nottingham UK found stroke patients receiving EMG biofeedback regained more arm function than patients who did not. Patients with more extreme impairment showed the most benefit. In 1994, a stroke rehabilitation center in Rome, Italy, showed similar benefits in biofeedback improving leg strength. Unfortunately, many of the studies demonstrating benefits for stroke patients have been criticized for their small sample size and imprecise terminology. As head of Rehabilitation at St. Joseph’s Health Care, London, Ontario, Dr. Robert Teasell reviewed studies performed between the 1960s and 2003. Teasell found that biofeedback did appear more effective than conventional therapies but that larger studies are needed to confirm these results. In 2006, the American Stroke Association updated this information by commenting that in the intervening years since Teasell’s review, essential research into biofeedback and stroke still had not occurred.
The Tutor system established in 2004 with the aim of developing novel occupational and physical therapy rehabilitation equipment based on the proven concepts of active exercise and biofeedback.
The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system 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 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 Important Tool in Post TBI Therapy

Zak Koeske writing in the Fairlawn Patch on October 9, 2011 reported about TBI survivor Jane Concato who discusses her own experience dealing with brain injury.
Early one morning about seven years ago, Jane Concato rose out of bed in her Westwood home and headed downstairs.
One false step during her descent changed her life forever.
“I fell down the steps,” said Concato, whose husband, Joe, heard the fall and came running to see what had happened.
Joe found his wife unconscious, squeezed up against the front door.
“He called 911 and then it just all began,” Jane said. “My life with a brain injury.”
Concato’s fall fractured her skull, bruising both her right and left temporal lobes. She remained in a coma at Hackensack Hospital for three excruciating weeks.
The doctors there prepared Concato’s husband for the worst.
“Joe would tell me that when I was in Hackensack Hospital, the neuropsychologist would say, ‘This might be it. She’ll survive, but she might never walk, she might never speak.’”
After coming out of her coma, Concato endured more than six months of cognitive remediation at the Kessler Institute for Rehabilitation in East Orange.
Her major cognitive deficits involved speech – both speaking and processing the speech of others – and problem solving. She also was suffering from depression, a common problem for individuals diagnosed with a traumatic brain injury because of the sudden and profound life change it brings about.
“One minute you’re,” Concato paused. “You’re just so different.”
Like many people, Concato didn’t know much about traumatic brain injury, or TBI, before her fall.
In the last seven years, awareness of the condition has grown — due in large part to the highly publicized TBI epidemic among returning war veterans and football players – even still, few know that the annual incidence of TBI is higher than that of breast cancer, multiple sclerosis, spinal cord injury and HIV/AIDS combined.
According to the Brain Injury Association of New Jersey, a TBI advocacy group, 12,000 to 15,000 of the 1.4 million people who suffer traumatic brain injuries annually are from New Jersey. BIANJ estimates that 175,000 New Jersey residents currently live with disabilities that resulted from traumatic brain injuries.
During recovery for TBI patients are heavily involved in physiotherapy. One of the newest methods to enable them to improve functional outcomes in their rehabilitation is through the use of the Tutor system.
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.

Post Hip and Knee Surgery Therapy Uses LegTutor

The Herald Sun’s Belinda Tasker writes on October 10, 2011 that the Australian Orthopaedic Association recorded 44,500 knee replacements and 36,000 hip replacements in 2010, a rise of almost eight per cent on the previous year.
Most of the procedures were carried out in private hospitals, with 68 per cent of all knee replacements and more than half of hip replacements performed for privately insured patients, according to the association’s registry.
The association’s president-elect, Graham Mercer, said the number of people under 55 having the surgeries had risen in the past five years.
“It’s a lifestyle thing,” Dr Mercer said.
“The main reasons for having a joint replacement are failed alternative treatments and the intrusion into their lifestyle (from hip or knee pain) is very significant.
”The one thing that really drives people to joint replacement is severe night pain despite medication and other treatments.”
During 2010, the number of knee replacements rose by 9.4 per cent, while the number of hip replacements increased by six per cent.
In more than 90 per cent of cases, the replacements remain a success a decade after they were carried out, according to the association.
Improving functional outcomes in physical therapy for post hip and knee replacements is crucial to the return to normal life patterns. This can be done effectively with the use of the newly created LegTutor.
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™, together with its sister devices (HandTutor, ArmTutor and 3DTutor) 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 and can be used by children as well as adults.

Tutor System Assists SCI Patients to Recover

Published Saturday October 8th, 2011 in the Daily Gleaner COLIN MCPHAIL writes that The Stan Cassidy Centre for Rehabilitation was the focus of attention on the second day of the Fredericton leg of the Rick Hansen 25th Anniversary Man In Motion Relay.
Thanks to the centre and an inspiration offered by Rick Hansen, Wilf Torunski, who has been in a wheelchair for the past 41/2 years drove there from his home in St. Stephen.
After suffering a spinal column injury caused by a bacterial infection, Torunski, 69, was on the brink of death and left without the ability to use his legs.
“I couldn’t even wiggle my toes,” he said to the crowd of more than 40 at the Stan Cassidy therapeutic recreational centre Friday morning.
“I went through a near-death experience. I couldn’t tell the difference between day and night. I was still hallucinating.”
He said his wife Donna was the catalyst to begin rehabilitation. Even though his chances of recovery were slim because of his age, 65 at the time, and his height, 6’3″, she kept pushing him and still does.
On Friday, Torunski sat in his wheelchair on the outdoor gazebo, dressed in the blue and yellow Rick Hansen relay tracksuit with the participation medal slung around his neck, with Hansen, Energy Minister Craig Leonard and Stan Cassidy medical director Dr. Rob Leckey.
Torunski underwent intensive physiotherapy at the Blusson Spinal Cord Centre in Vancouver. He was accepted into the first Lokomat Research Project under Dr. Tania Lam at the Blusson Centre – the home of the Rick Hansen Institute. The project was designed to ensure patients could walk using a walker.
After the successful experiment, the couple moved across the country to settle in St. Stephen. The Canadian Paraplegic Association of New Brunswick – now called Ability NB – then turned him on to the Stan Cassidy centre. He said he was thrilled with his progress.
“If I could get to as far as walking with a walker or getting into a car, I’d be happy,” he said.
However, he felt the urge to continue and push his limits. Now that he could stand with a walker, he asked the centre to help him reach the next step.
“That’s what this place has done,” Torunski said, beaming.
The technology and therapy provided him with the tools to operate a vehicle on his own. Four years after being told he would never walk again, Torunski is driving to his rehabilitation sessions in Fredericton two to three times a week – with supervision, of course.
“In all the years since our tour, there has been a tremendous evolution and revolution in health care, as well as new hope for with spinal cord injuries,” Hansen said to the crowd.
He said the odds of some form of recovery has jumped from 30 per cent to 70 per cent since he embarked on his Man In Motion journey 25 years ago.
The LegTutor and its sister devices (HandTutor, ArmTutor and 3DTutor) have been used in physiotherapy with victims of Spinal Column Injury and MS for some time now.
The Tutor system is used in an inpatient, outpatient and home rehabilitation environment as an aid in order to achieve the patient’s functional ability goal as much as possible. The Tutor system consists of ergonomic wearable devices together with powerful dedicated rehabilitation software.
It is designed for those who have head, trunk, upper and lower extremity movement dysfunction as a result of stroke, Parkinson’s disease, CP or post arm and leg surgery in addition to those mentioned above. 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 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.

Guitar Playing Again a Real Possibility With the Help of the Tutor System

ROBERT REMINGTON writes in the CALGARY HERALD on OCTOBER 8, 2011 about Al Hubbard.
Comatose and written off for dead six years ago by the medical establishment, “Iron” Al Hubbard strapped on his guitar and played me a couple of tunes this week – a remarkable accomplishment, considering the seemingly hopeless vegetative state from which he has emerged.
When we met a year ago, the retired teacher and former Ironman triathlete could barely even hold his guitar. Today, he can coax his stiff fingers to form chords. On Wednesday, he will perform two songs at an annual fundraising breakfast for the Association for the Rehabilitation of the Brain Injured (ARBI), a Calgary non-profit organization that has slowly nurtured him back from the debilitating effects of a severe stroke.
“He has come miles,” says Jane Dafoe, ARBI’s fund development manager.
In 2005, Hubbard, a former French immersion teacher and six-time finisher of the Penticton, B.C., Ironman competition, suffered a stroke that left him in a vegetative coma for two weeks. “I died three times,” he says of the trio of attempts to revive him when his heart stopped.
Doctors began to discuss end-of-life options with his family, who refused to give up. Instead, they got him into ARBI, which has been working with the profoundly brain injured since 1978.
Brain injury rehabilitation is often slow and unpredictable, as the arduous recovery of Pittsburgh Penguin star Sidney Crosby has shown. Hubbard, despite his tremendous will to improve, admits he is getting frustrated.
“It’s not going fast enough for me,” he said as we sat together this week, restringing his guitar. Hubbard, who recently turned 66, remains determined to one day compete in another triathlon. He will soon begin bicycle rehabilitation and hopes to ride the Penticton triathlon route next August on a three-wheeled competitive tricycle.
While the extent of recovery from a brain injury can’t be forecast, Hubbard has several key elements going for him.
“Alan has motivation, he works hard, and has incredible family support,” says his physiotherapist, Nancy Pullan.
Hubbard’s speech is much stronger than it was a year ago. He can walk short distances with assistance and can read words on a printed page for up to 30 minutes.
“The ability to read will give him tremendous quality of life,” says occupational therapist Ana Gollega. “We attempt to identify a person’s passions. Alan was a teacher, so reading is very important to him.”
His guitar was another key element in his rehabilitation. Beginning with exercises using clothespins to build strength, Hubbard can now play three simple chords. Once unable to even swallow, and completely non-verbal when he arrived at ARBI, he can now sing complete songs.
About 10,000 Albertans suffer a brain injury each year, according to ARBI. I was one of them two years ago when a ski accident left me unconscious and suffering from a severe concussion that abated after about a month.
I was lucky and didn’t need rehab. In Calgary, help is readily available to those who are severely disabled and show progress in the first six months. But those who remain in one of several states known collectively as “disorders of consciousness” often fall through cracks. These slower-to-recover individuals, who at times remain in a minimally responsive state, are the ones that ARBI takes in. It is the only communitybased organization in Alberta that offers the slow, long-term help required for the “hard cases” like Hubbard.
ARBI helps about 100 people a year, with demand growing. Most of its clients are stroke victims like Hubbard, although young victims with traumatic brain injury from accidents are also ARBI clients.
Hubbard is currently in a care facility, but has progressed to the point where he may soon be able to live with one of his daughters and, eventually, independently.
“I have a great family,” he says.
Included in that definition, he would agree, are the dedicated volunteers and professionals at ARBI who are giving him back his life.
Victims of brain injury and stroke can benefit greatly from the Tutor system. These devices known as the HandTutor, ArmTutor, LegTutor and 3DTutor have already been used successfully in leading U.S. and foreign hospitals and clinics.
The newly developed HandTutor and its sister devices have become a key system in neuromuscular rehabilitation and physical therapy for post stroke and TBI patients. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. The exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. Customized software allows the therapist to adjust the program to the patient’s ability. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Telerehabilitation allows the system to be used at home. The devices are suitable for children as well as adults.

Fine Motor Activities for Children and the Tutor System

Fine motor skills occur when the small muscles in the hands/fingers move in coordination with the eyes.
Fine motor skills will usually develop later than gross motor skills. Some of the first fine motor skillsyou may see in infants are done with the hands/arms such as raising their arm up and down or waving with their hand.
Fine motor skills take more effort to develop than do gross motor skills due to changes in their bodies during the growth and development of the nervous system. Providing age appropriate tools in the classroom and/or around the home will help with these changes during growth, making motor development successful.
Fine motor skills are learned using the small muscles in the hands and fingers. Examples of activities which involve the use of fine motor skills are , cutting with scissors, coloring, button and zipper activities, scribbling, lacing, puzzles, peg puzzles,turning pages in a book, playing with play dough,etc.
Developing fine motor skills can be challenging, but it doesn’t have to be boring or discouraging. Providing children with the tools, space, and time they need to engage in these activities is the best and most effective way to promote learning in a positive, encouraging, and educational enviroment.
When fine motor skills are disturbed in children due to disabling diseases such as CP, MS, brain or spinal cord injury or surgery the Tutors are a welcome and a helpful device that children enjoy using.
The HandTutor, ArmTutor, Leg Tutor and 3d Tutor have been developed to teach children how to reuse their joints. The unique and successful devices use a dedicated software that utilizes games to enhance and improve their movement.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.
The ”Tutors” also use tele rehabilitation for those patients that are home bound or who have recovered sufficiently to get their treatment at home. Leading U.S. and foreign hospitals and outpatient clinics now use the devices whic

LegTutor an Important Aid to Post Knee Surgery Therapy

On Oct. 7, 2011 in the Shreveport Times, Melody Brumbe writes about Anita Boutin who tried it all before going under the knife to replace her arthritis-ravaged knee in August. “I can remember 20 years ago not being able to squat ” Boutin, 63, said. “It didn’t hurt then but before I had surgery it had gotten to the point where it hurt even when I was sitting at my desk at work.”
Knee replacement surgeries are expected to soar as Baby Boomers try to stay active longer, but self-care treatments can help with pain, restore mobility and delay or eliminate the need for surgery., “Total knee replacement is an epidemic in our country,” says Marj Albohm, president of the National Athletic Trainers’ Association. “That circles back to the American way. Fix it. Give me an operation.”, Replacement operations increased 100 percent over the past 10 years and are expected to rise 500 percent by 2030, according to the American Academy of Orthopedic Surgeons. Traumatic injuries and osteoarthritis, which troubles 27 million American adults by damaging cartilage and bone and causing pain, stiffness and swelling, can lead to expensive surgeries.
A knee replacement ranges from $45,000 to $60,000., Boutin, of Keithville, tried physical therapy and shots of an artificial joint lubricant to put off surgery. Neither offered much relief, but she’s seen a huge difference two months after Dr. Richard Harrell removed the damaged joint and put in an artificial one., “It’s great. I still have a tiny bit of pain and there’s pain when I get up and down, but the pain is diminishing day by day,” Boutin said. “My goal? I want to be able to stand with no pain and walk with no pain. Anything above that is lagniappe.” Boutin is typical of the patients orthopedic surgeon Dr. Steven Atchison sees. Atchison estimates that the average age of knee replacement patients in northwest Louisiana is 63. “Probably 75 percent of the people we see in the clinic for knee and hip pain have already tried other things,” he said. “Surgery is done almost exclusively because of pain. It’s a quality-of-life issue first, then functionality second.”
Post knee surgery therapy can be augmented with the use of the LegTutor. 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.

Patient’s Efforts with the Tutor System Effective for TBI

Dr. Catherine Dalton etal of the Regional Neurological Rehabilitation Unit of the Homerton University Hospital, London, UK writing in CLINICAL REHABILITATION on Sept. 2011 conducted a study with an objective to investigate the effects of patient participation in multidisciplinary goal setting during early inpatient rehabilitation after acquired brain injury.
The study was conducted in the Regional Neurological Rehabilitation Unit. One hundred and five patients with acquired brain injury participated. The main measures incorporated were the following: Numbers of goals set and achieved per patient before and after intervention; Barthel Index and Functional Independence Measure.
The results of the intervention resulted in a significant increase in the number of goals set per patient (340 versus 411 total goals, mean per patient 6.3 pre versus 8.05 post, P = 0.008). More patients had multiple goals set within each domain (P = 0.023). There was an increase in the number of patients with sleeping (0 pre, 9 post), continence (3 pre, 17 post) and leisure (15 pre, 35 post) goals set, and leisure goals achieved (60% pre and 68% post, P < 0.001). Correlations between goal achievement and change in activity-related outcome measures (Barthel Index and Functional Independence Measure) also improved with the new goal setting process. The proportion of goals achieved remained similar (60% pre and 63% post intervention), suggesting there was no evidence of inappropriate or unachievable goals set when the patient and family were included.
The conclusions reached were that real-time engagement of brain-injured patients in the goal setting process during early inpatient rehabilitation is achievable, but requires a structured multidisciplinary assessment of need. We found it increases the number of domains in which goals are set and includes functional areas not rated by commonly used global measures of outcome during inpatient rehabilitation.
When the Tutor (HandTutor, ArmTutor, LegTutor and 3DTutor) system is used in an inpatient rehabilitation environment for brain injury patients the main aspect is that the patient’s own efforts and participation are what affords improvement in range of motion and movement. The system uses set goals that are created by the patient himself through the use of dedicated and customized software. The Tutor system consists of ergonomic wearable devices together with powerful dedicated rehabilitation software. It is designed for those who have head, trunk, upper and lower extremity movement dysfunction. The Tutor 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 patients to better perform everyday functional tasks to improve their quality of life. Telerehabilitation allows the patients to use the system in an outpatient clinic or at home as well. The Tutor system is FDA and CE certified.

SCI and TBI therapy incorporates Tutor System

Just announced on PRNewswire the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education awarded a $2.28 million federal grant to Kessler Foundation. The five-year grant funds the Northern New Jersey Spinal Cord Injury System (NNJSCIS), a comprehensive system of care, research, education and dissemination aimed at improving quality of life for people with spinal cord injury. The NNJSCIS is a cooperative effort of Kessler Foundation, Kessler Institute for Rehabilitation, and the University of Medicine and Dentistry of New Jersey in Newark.
“Our collaborative system is excited to receive this recognition of our comprehensive services and research activities in the realm of spinal cord injury,” said Steven Kirshblum, MD, co-director of the NNJSCIS. “We look forward to continuing our dedication to individuals with these catastrophic injuries.” Dr. Kirshblum is medical director of Kessler Institute for Rehabilitation and director of SCI Services.
NNJSCIS collects patient data from the time of injury through long-term followup, which is contributed to the National SCI Statistical Center. Data are used to identify areas where investigation is needed.
“With this grant, we can continue to examine obstacles to recovery and full participation in our community,” said Trevor Dyson-Hudson, MD, co-director of the NNJSCIS and interim director of SCI Research at Kessler Foundation. “Everything changes for the person with spinal cord injury, not just mobility,” he stressed. “That’s why we also look at factors that are important to overall quality of life like access to medical care, pain management, employment and aging with a spinal cord injury. What we learn here in New Jersey furthers research for all people with spinal cord injury.”
Kessler will conduct a study of a combination therapy using dalfampridine—a drug recently approved to improve walking in patients with multiple sclerosis—with a standardized program of locomotor training, a rehabilitative intervention that has improved walking and other functional outcomes in persons with spinal cord injuries.
“I’m incredibly proud to represent the Kessler Foundation in Congress and to champion their tireless efforts to improve the lives of those living with spinal cord injury and traumatic brain injury,” said U.S. Rep. Bill Pascrell, Jr. (D-NJ-8). “This new research study has the potential to provide new breakthroughs in our understanding of spinal cord injury. It will surely add to the impressive body of work that Kessler Foundation and Kessler Institute have accomplished in improving rehabilitation for those affected by spinal cord injuries.”
Patients with TBI and SCI have a friend in the Tutor system. These newly developed devices are comfortable braces or (in the case of the HandTutor) an ergonomic glove that, together with powerful dedicated rehabilitation software, optimize the patient’s motor, sensory and cognitive performance and allows for the patient to better perform everyday functional tasks to improve their quality of life. The software uses games to assist the patient in renewing his movement skills.
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 and 3DTutor an Integral Part of Upper Extremity Rehabilitation

As published in the Journal of Pediatric Neurosciences Selvam Ramachandran and Preeti Thakur of the
Department of Physiotherapy, Sikkim Manipal Institute of Medical Sciences, Tadong, Gangtok, East Sikkim, India discuss: Upper extremity constraint-induced movement therapy in infantile hemiplegia
Infantile hemiplegia is one of the clinical forms of cerebral palsy that refers to impaired motor function of one half of the body owing to contralateral brain damage due to prenatal, perinatal and postnatal causes amongst which vascular lesion is the most common causative factor. We report here the effects of constraint-induced movement therapy in a five-year-old female child with infantile hemiplegia on improvement of upper extremity motor skills.
Keywords: Constraint-induced movement therapy, infantile hemiplegia, shaping
Introduction
The potential use of the affected upper extremity of children with hemiplegia often fails due to “learned non-use phenomenon”. Constraint-induced movement therapy (CIMT) is one of the treatment strategies which utilizes the principles of neural plasticity to help acquire motor skills of the affected upper extremity. This therapeutic approach involves constraining of the unaffected upper extremity using sling, plaster cast, mitt or splints and intensive training of the affected upper extremity with task-specific, goal-oriented activities by reinforcement (shaping technique).
Case Report
A five-year-old female child presented with right hemiplegia with the history of delayed motor milestones and limited motor skills of the right upper extremity since birth. The history given by parents was suggestive of birth asphyxia. The objective details of the cause of hemiplegia could not be established as there were no medical records available. The child had no history of seizure or any other form of developmental delay. The child had not undergone any physical therapy interventions earlier. Presently, she has achieved the highest level of functional independence (able to walk and run independently). She displayed no voluntary effort to initiate any motor skills of the right upper extremity unless verbally prompted, even otherwise initiating only minimal response suggesting learned non-use phenomenon. The following criteria were considered for use of CIMT in this child (adapted from Cochrane review study).
Observed learned non-use of affected upper extremity.
A possible movement of at least 10° extension at metacarpophalangeal and inter-phalangeal joints and 20° extension at wrist of the affected upper extremity.
No cognitive impairment shall cooperate with treatment.
Outcome measure: Quality of upper extremity skills test
The Quality of Upper Extremity Skills Test (QUEST) is a criterion-referenced measure that evaluates the quality of upper extremity function in four domains: dissociated movements , grasps , weight-bearing and protective extension . It is designed to be used with children who exhibit neuromotor dysfunction with spasticity and has been validated with children 18 months to eight years of age. The data collected during the Neuro Developmental Therapy/Casting study by Law et al., were used to analyze the validity and responsiveness of the QUEST.
The parents of the child were counseled for the treatment approach that could improve the motor skills of the affected right upper extremity. The parents were interested and were keen in subjecting their child to this treatment approach and gave informed consent. The pre-intervention assessments of the right upper extremity motor skills were measured using QUEST. The unaffected left upper extremity was constrained with posterior slab plaster cast extending above the elbow to the interphalangeal joints of fingers and supported with a sling. The parents were instructed to maintain the constraint for at least two weeks. The affected right upper extremity was then subjected to task-specific goal-oriented activities that aimed to improve reaching, grasps, manipulation and release of the object using the arm and hand. The activities were encouraged using play way method and reinforcements using visual (postural mirror) and verbal feedback. The therapy session usually lasted for one hour a day for five days a week. The parents were instructed to constantly encourage the same activities that were carried out during the treatment session in daily activities. At the end of the two-week period, post-intervention assessment of the right upper extremity was done using QUEST. As there was an incremental response in the outcome measure, the investigators convinced the parent to continue the treatment for another week. At the end of three weeks, once again post-intervention assessment was done.
Results
As the QUEST measure analyzes the quality of motor skills of both the right and left extremity, it may be noted that the pre-intervention percentage score was 53.04% indicating full percentage score of unaffected left upper extremity and marginal percentage score of affected right upper extremity. Following intervention, increments in percentage score by 26.79% and 07.51% were observed at the end of two weeks and three weeks respectively which should be attributed to the improvements in the quality of motor skills of the affected right upper extremity. It may also be noted that the grasp percentage score was greater than other domains indicating better improvement in fine motor skills than gross motor skills. The overall increment observed was 34.30%.
Discussion
The main concern for the parents in the use of CIMT for improving the motor skills of the affected upper extremity in infantile hemiplegia was the fact that it restricts the use of the unaffected extremity. The success of the use of CIMT in infantile hemiplegia depends on the parents, their proper understanding of the concept of the approach and their deep motivation in carrying out home exercises. The increments in percentage scores observed in this case report are attributed to the increased demands for the use of the affected upper extremity while constraining the unaffected upper extremity through task-specific goal-oriented activities that were reinforced with visual and verbal feedback.
Conclusion
The observation of this case report indicates that the use of CIMT could reverse the learned non-use phenomenon of the affected upper extremity in infantile hemiplegia and thus reduce disability to greater extent.
The ArmTutor facilitates evaluation and treatment of the upper extremity including isolated and combined shoulder and elbow movements. The ArmTutor™ 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 together with its sister devices (HandTutor, LegTutor and 3DTutor) is suitable for children as well as adults suffering from a variety of disabilities.
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.
.

Post TBI and SCI Therapy enhanced by Tutor System

The National Institute on Disability and Rehabilitation Research of the U.S. Department of Education awarded a $2.28 million federal grant to Kessler Foundation of WEST ORANGE, N.J. as reported by PRNewswire on Oct. 4. The five-year grant funds the Northern New Jersey Spinal Cord Injury System (NNJSCIS), a comprehensive system of care, research, education and dissemination aimed at improving quality of life for people with spinal cord injury. The NNJSCIS is a cooperative effort of Kessler Foundation, Kessler Institute for Rehabilitation, and the University of Medicine and Dentistry of New Jersey in Newark.
“Our collaborative system is excited to receive this recognition of our comprehensive services and research activities in the realm of spinal cord injury,” said Steven Kirshblum, MD, co-director of the NNJSCIS. “We look forward to continuing our dedication to individuals with these catastrophic injuries.” Dr. Kirshblum is medical director of Kessler Institute for Rehabilitation and director of SCI Services.
NNJSCIS collects patient data from the time of injury through long-term followup, which is contributed to the National SCI Statistical Center. Data are used to identify areas where investigation is needed.
“With this grant, we can continue to examine obstacles to recovery and full participation in our community,” said Trevor Dyson-Hudson, MD, co-director of the NNJSCIS and interim director of SCI Research at Kessler Foundation. “Everything changes for the person with spinal cord injury, not just mobility,” he stressed. “That’s why we also look at factors that are important to overall quality of life like access to medical care, pain management, employment and aging with a spinal cord injury. What we learn here in New Jersey furthers research for all people with spinal cord injury.”
Kessler will conduct a study of a combination therapy using dalfampridine—a drug recently approved to improve walking in patients with multiple sclerosis—with a standardized program of locomotor training, a rehabilitative intervention that has improved walking and other functional outcomes in persons with spinal cord injuries.
“I’m incredibly proud to represent the Kessler Foundation in Congress and to champion their tireless efforts to improve the lives of those living with spinal cord injury and traumatic brain injury,” said U.S. Rep. Bill Pascrell, Jr. (D-NJ-8). “This new research study has the potential to provide new breakthroughs in our understanding of spinal cord injury. It will surely add to the impressive body of work that Kessler Foundation and Kessler Institute.
Treating spinal cord and brain injury victims with appropriate therapy tools is extremely important. The Tutor system has shown to be very effective in such post trauma therapy.
When TBI occurs and recovery is progressing the Tutor system (HandTutor, ArmTutor, LegTutor, 3DTutor) has shown much success in rehabilitation of joint movement. 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 will help to prevent the development of compensatory movement patterns. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. In addition the therapist can objectively and quantitatively evaluate and report on the treatment progress. The rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows the patient to better perform everyday functional tasks to improve their quality of life. The Tutor system is FDA and CE certified.

LegTutor Twice as Helpful in Bilateral Knee Replacement Therapy

As reported on NBC’s Channel 2 in Ft. Meyers, Florida on Oct. 4 the story of Chris Naylor is encouraging.
If one bad knee wasn’t bad enough, Chris Naylor had two. When her walk turned to a hobble, she sprang into action.
“It finally reached the point where there was enough crunching bone on bone that is was making life very difficult.”
Chris underwent a staged, bilateral knee replacement. The procedure resurfaces the knee joint, shaving away damaged cartilage and bone. Surgeons cap the resurfaced bones to keep much of the knee intact.
“The good parts stay; the ligaments and the muscles and tendons really; we keep as much of your own parts as we can,” says Dr. Ed Humbert, an orthopedic surgeon on the medical staff of Lee Memorial Health System.
It’s not the surgery itself that solely determines success or failure. Once the surgery is over, the real work begins.
“Physical therapy with knee replacement is very, very important. Even the best implant or knee replacement put in properly and perfectly, if that patient did very little therapy can become very stiff and very painful,” says Dr. Humbert.
Chris approached her recovery with a sense of purpose, planning a trip to Disney within weeks of her last surgery. She jumped into physical therapy with both feet.
“The day of surgery you’re left alone, the following morning physical therapy starts morning and afternoon, the day after that you are released – it’s also morning and afternoon, you’re sent home, physical therapy calls that evening and they start coming into the home the next day,” says Chris.
“Therapy’s helping your range of motion, it’s progressing and getting your strength back and therapy’s also part in keeping the swelling down,” says Dr. Humbert.
The hard work paid off, Chris’ smile says it all.
“I went to Disney; we did all four parks in three days with two new knees, and I survived wonderfully.”
The rest of her was exhausted, but her rebuilt knees held up fine.
The LegTutor has become an integral part of post knee surgery therapy.
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, which includes the HandTutor, ArmTutor and 3Dtutor, is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home with telerehabilitation.

ArmTutor Refines Arm Movement Post Surgery

Writing in the WEEI.COM BLOG NETWORK Alex Speier reports that Daisuke Matsuzaka remains on schedule in his return from Tommy John surgery. (AP) Red Sox pitcher Daisuke Matsuzaka played catch for the first time since undergoing Tommy John surgery in June to repair the torn ulnar collateral ligament in his right elbow. According to the Kyodo News (via JapanBall.com), Matsuzaka threw 39 times from “short range” in Fort Myers as a starting point to the gradual rebuilding of his arm strength. After the throwing session, the 31-year-old reflected on what he considered a significant milestone in his rehab process. ”I have been waiting a long time for this day,” Matsuzaka told reporters in Fort Myers. ”It was the first time I threw a ball in awhile but I was relieved because my elbow didn’t hurt at all,” he said. ”I was nervous about my first throw because I didn’t want to throw it in a strange way. Since it was my first time holding a baseball in a long time, I wasn’t quite sure about my release.” Matsuzaka made just eight appearances (seven starts) in 2011, going 3-3 with a 5.30 ERA before suffering the elbow injury that ultimately required season-ending surgery. While he remained true to the wildly inconsistent form he’d shown over the last three seasons, his absence nevertheless contributed to the decimation of the Red Sox’ starting pitching depth that ultimately contributed to the team’s collapse in September. While Matsuzaka has a stated goal of returning sometime in the second half of the 2012 season — the last of the six-year, $52 million deal he signed with the Sox after Boston won its posting bid of $51.11 million on him in Nov. 2006 — it remains to be seen whether he ever pitches in a major league game for the Sox again. That said, to date, Matsuzaka’s recovery from Tommy John has remained very much on schedule. Going forward, Matsuzaka said that he hopes to throw every other day, and he acknowledged that he will take more time both in preparing for his throwing sessions and getting post-throwing treatment. In five seasons with the Sox, Matsuzaka is 49-30 with a 4.25 ERA while striking out 8.2 batters per nine innings and walking 4.4 hitters per nine. He will make $10 million in 2012. Matsuzaka has an even better chance of recuperating form his Tommy John surgery with the help of the ArmTutor. 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™ together with its sister devices, HandTutor, LegTutor and 3DTutor, is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

How the LegTutor Helps Exercise Walking

“Walking is man’s best medicine.”
-Hippocrates
Hippocrates must have been a smart guy! There’s a wealth of research to prove that walking is good for you and the results are impressive: major reductions in both diabetes and heart disease, decreases in high blood pressure, increases in bone density, and more all follow regular walkingexercise. This according to William C. Shiel Jr., MD, FACP, FACR
In this article, I’ll cover how walking can help you, how much you need to do to gain benefits, types of walking and techniques, how to get started, and other valuable information.
Walking is one of the easiest and least expensive ways to stay physically fit. It’s also a versatile form of exercisethat can be done indoors (many malls and public buildings offer walking routes) or outdoors, and you can tailor the intensity of your exercise based upon your individual abilities and goals. Whether you’d like to begin walking for exercise or if you’re already established in the habit, these tips can help you get the most from your workout.
Before starting a walking program, check with your doctor if you have a chronic medical condition or if you have had a recent injury. But don’t assume that you aren’t able to start exercise walking if you do have medical issues. Exercise walking can help control disease progression and relieve symptoms in people with cardiovascular disease and diabetes, and many people with arthritis or other musculoskeletal problems will experience symptom relief from a medically-supervised exercise walking routine.
Invest in good shoes. Since these are the only expense and equipment you’ll need, pay attention to the fit and quality of your shoes. Shoes should fit when you try them on without any areas of pinching or pressure that could cause blisters or calluses. Wear the type of socks you’ll wear when walking when you purchase your shoes, and remember that you’ll likely need a larger-sized shoe than you normally wear if you plan to wear thick socks. Shoes should have good arch support and a slightly elevated heel with stiff material to support the heel when walking and prevent wobbling.
Always warm up by walking at a slow or normal walking pace for five minutes before picking up the tempo of your workout.
Do you remember your first step?
Remember your first step? What a fuss everyone made! And then you continued to walk right on through childhood, adolescence, and into adulthood, but somewhere along the way, like most adults, you probably stopped walking so much. In fact, the percentage of adults who spent most of their day sitting increased from 36.8% in 2000 to 39.9% in 2005! Part of the reason may be your hectic,stressful life, with not a moment to spare for recreation or formal exercise. The environment plays a part too; inactivity has been engineered into our lives, from escalators to remote controls to riding lawn mowers to robotic vacuum cleaners to electric toothbrushes to the disappearance of sidewalks and safe places to walk. But research shows that all this automation is bad for our health. Inactivity is the second leading preventable cause of death in the United States, second only to tobacco use.
You’d think a simple activity like walking would be just that, simple. But fewer than 50% of American adults do enough exercise to gain any health or fitnessbenefits from physical activity. Is walking our salvation? I don’t know for sure, but evidence suggests that it’s probably a good start.
Top 10 reasons to walk?
1.
Walking prevents type 2 diabetes. Walking 150 minutes per week and losing just 7% of your body weight (12-15 pounds) can reduce your risk of diabetes by 58%.
2.
Walking strengthens your heart if you’re male. In one study, mortality rates among retired men who walked less than one mile per day were nearly twice that among those who walked more than two miles per day.
3.Walking strengthens the heart if you’re female.
Women in the Nurse’s Health Study (72,488 female nurses) who walked three hours or more per week reduced their risk of a heart attack or other coronary event by 35% compared with women who did not walk.
4.
Walking is good for your brain.
In a study on walking and cognitive function, researchers found that women who walked the equivalent of an easy pace at least 1.5 hours per week had significantly better cognitive function and less cognitive decline than women who walked less than 40 minutes per week. Think about that!
. 5
Walking is good for your bones.
Research shows that postmenopausal women who walk approximately one mile each day have higher whole-body bone density than women who walk shorter distances, and walking is also effective in slowing the rate of bone loss from the legs.
6.
Walking helps alleviate symptoms of depression.
Walking for 30 minutes, three to five times per week for 12 weeks reduced symptoms of depression as measured with a standard depression questionnaire by 47%.
7.
Walking reduces the risk of breast and colon cancer.
Women who performed the equivalent of one hour and 15 minutes to two and a half hours per week of brisk walking had an 18% decreased risk of breast cancer compared with inactive women. Many studies have shown that exercise can prevent colon cancer, and even if an individual person develops colon cancer, the benefits of exercise appear to continue both by increasing quality of life and reducing mortality.
8.
Walking improves fitness.
Walking just three times a week for 30 minutes can significantly increase cardiorespiratory fitness.
9.
Walking in short bouts improves fitness, too!
A study of sedentary women showed that short bouts of brisk walking (three 10-minute walks per day) resulted in similar improvements in fitness and were at least as effective in decreasing body fatness as long bouts (one 30-minute walk per day).
10.
Walking improves physical function.
Research shows that walking improves fitness and physical function and prevents physical disability in older persons.
When walking is hindered due to a disease or injury the LegTutor™ is a system that 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™, together with its sister devices (HandTutor, ArmTutor and 3DTutor), system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

Tutors Help Maintain Current Strength in Arthritis Sufferers

Janice Lloyd writing in USA Today, October 2011 states:
The American Academy of Orthopedic Surgeons developed the 2008 treatment guidelines for osteoarthritis of the knee to include only treatments less invasive than joint replacement. Not all the regimens are recommended because scientific evidence is lacking.
Not recommended
» Glucosamine and/or chondrotin sulfate: “Most of the studies recommending it have been done by the industry,” said John Richmond, chair of the AAOS task force that drew up the guidelines. One study concluded there were no clinical benefits compared with a placebo.
Cannot recommend for or against
» Various braces: “These might help some individuals, but overall, we didn’t recommend them because they don’t work on overweight or obese people,” Richmond said
» Acupuncture: The guidelines cite conflicting studies and studies that said the “effects of acupuncture were not statistically significant.”

More
If your knees start throbbing like those of post-game NFL players, remember all of your options – and not just the easy ones, health experts say.
Knee replacement surgeries are expected to soar as baby boomers try to stay active longer, but self-care treatments can help with pain, restore mobility and delay or eliminate the need for surgery.
“Total knee replacement is an epidemic in our country,” said Marj Albohm, president of the National Athletic Trainers’ Association. “That circles back to the American way. Fix it. Give me an operation.”
Replacement operations increased 100 percent over the past 10 years and are expected to rise 500 percent by 2030, according to the American Academy of Orthopedic Surgeons. Traumatic injuries and osteoarthritis, which troubles 27 million American adults by damaging cartilage and bone and causing pain, stiffness and swelling, can lead to expensive surgeries.
The best ways to slow down arthritis and help preserve cartilage cushioning knees and other joints are to follow the Arthritis Foundation‘s guidelines, said John Richmond, chairman of the group who wrote the AAOS 2008 guidelines for treatments less invasive than knee replacements. At the top of the list is losing weight.
“The only treatment that actually slows down the progress of the disease is weight loss,” said Richmond, chairman of New England Baptist Hospital’s department of orthopedic surgery in Boston. “You might think restricting activity would help, but it does not.”
Every pound lost reduces the weight on your knees by 4 pounds, said Patience White, chief public health officer of the Arthritis Foundation, which funds research for treatments and a cure.
Among the Arthritis Foundation’s strategies to combat pain and restore mobility:
» Get exercising: Include low-impact aerobic exercises (cycling, brisk walking, gardening and dancing) in your workout routine. “We can’t say this enough. Exercise helps with pain and is good for overall health,” White said.
» Increase muscle: Work all the muscle groups twice a week. Stronger muscles can help support damaged joints.
If your knees start throbbing like those of post-game NFL players, remember all of your options – and not just the easy ones, health experts say.
Knee replacement surgeries are expected to soar as baby boomers try to stay active longer, but self-care treatments can help with pain, restore mobility and delay or eliminate the need for surgery.
“Total knee replacement is an epidemic in our country,” said Marj Albohm, president of the National Athletic Trainers’ Association. “That circles back to the American way. Fix it. Give me an operation.”
Replacement operations increased 100 percent over the past 10 years and are expected to rise 500 percent by 2030, according to the American Academy of Orthopedic Surgeons. Traumatic injuries and osteoarthritis, which troubles 27 million American adults by damaging cartilage and bone and causing pain, stiffness and swelling, can lead to expensive surgeries.
The best ways to slow down arthritis and help preserve cartilage cushioning knees and other joints are to follow the Arthritis Foundation’s guidelines, said John Richmond, chairman of the group who wrote the AAOS 2008 guidelines for treatments less invasive than knee replacements. At the top of the list is losing weight.
“The only treatment that actually slows down the progress of the disease is weight loss,” said Richmond, chairman of New England Baptist Hospital’s department of orthopedic surgery in Boston. “You might think restricting activity would help, but it does not.”
Every pound lost reduces the weight on your knees by 4 pounds, said Patience White, chief public health officer of the Arthritis Foundation, which funds research for treatments and a cure.
Among the Arthritis Foundation’s strategies to combat pain and restore mobility:
» Get exercising: Include low-impact aerobic exercises (cycling, brisk walking, gardening and dancing) in your workout routine. “We can’t say this enough. Exercise helps with pain and is good for overall health,” White said.
» Increase muscle: Work all the muscle groups twice a week. Stronger muscles can help support damaged joints.
Intensive exercise practice is proven to improve functional movement ability following orthopedic and neurological injury and disease. Patient motivation and control of the exercise practice are the fundamental factors that are required for optimum functional recovery. Traditional practice is mostly based on low technology tools that intrinsically lack features to challenge and motivate the patient to intensive exercise training. In addition low technology tools do not provide sufficient resolution to completely control the required exercise performance.
Using the HandTutor for hand and wrist arthritis problems and the LegTutor for foot and ankle arthritis problems can help maintain current strength.
The Tutor system, which also includes the ArmTutor 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 Tutor devices are currently assisting patients in leading U.S. and foreign hospitals and clinics and are FDA and CE certified.

Children Benefit From Tutor System After Stroke

Linda Childers writing in PT.com on September 19, 2011 tells this story.
It’s early morning when Teresa Gill, PT, walks into her patient’s room, introduces herself, and explains how they will work together to overcome the gait problems and muscle weakness that her patient sustained due to a recent stroke. Gill’s patient isn’t a spry octogenarian, but rather a 6-year-old girl who wants to know when she will be able to play soccer again. Each year, about 4,000 children in the U.S. experience a bleed or blockage of the blood flow in their brain that characterizes a stroke, according to the American Heart Association. Certain conditions such as congenital heart problems, arteriovenous malformations, hemophilia and sickle cell disease also can cause stroke in children.
While the vast majority of strokes occur in those older than 65, U.S. Centers for Disease Control research presented at the International Stroke Conference in Los Angeles this past February, showed that ischemic strokes are increasing among children and younger adults. Between 1995 and 2008, hospitalizations among those ages 5 to 14 increased 31%, from 3.2 per 10,000 to 4.2 per 10,000. Among those ages 15 to 34, hospitalizations increased 30% from 5 per 10,000 to 6.5 per 10,000, researchers found.
Although this study didn’t explore reasons for the trend, CDC researchers point to increased childhood obesity — which can lead to risk factors including heart disease and diabetes — as well as better diagnoses using MRI as likely factors.
Team push
For physical therapists such as Gill, who works at Children’s Hospital in Oakland, Calif., treating childhood stroke survivors involves serving as part of an interdisciplinary team that works to help children relearn their motor skills. This often means working with infants who have suffered a stroke in utero. “We are fortunate enough to have physical therapists here at Children’s who work with patients in the neonatal intensive care unit and pediatric intensive care unit as soon as they are medically stable,” Gill said.
While infants may not show signs of deficits immediately after a stroke, effects often become apparent as they grow older. Four of five newborns who experience a stroke around the time of birth develop neurologic disorders such as cerebral palsy or epilepsy, according to the American Stroke Association. “Treatment time and the frequency of physical therapy sessions depend upon the severity of a child’s injury,” Gill said. “Recovery can range from acute inpatient physical therapy to acute intensive rehabilitation, and often includes outpatient physical therapy. A typical inpatient course can last between six to eight weeks; outpatient physical therapy may continue for years as the patient continues to make gains.”
Symptoms, severity
While some children recover under a physical therapy regimen after sustaining a stroke, others suffer long-term residual effects. “Because [deficits in] children with strokes can be multifaceted, neurorehabilitation includes many different therapies to help children regain the use of their brain function,” said Richard Gee, PT, of Lucile Packard Children’s Hospital in Palo Alto, Calif. “The therapies focused for pediatric stroke patients are specific for the symptoms that are present secondary to the stroke, and are also age specific to the child.”
Gee said that symptoms he encounters with pediatric stroke survivors include spasticity; decrease in range of motion; weakness; paralysis; speech, language and communication problems; aphasia; hemiparesis; neglect of the affected side; decreased vision; dysphagia; and swallowing difficulties. Because their brains are still developing, children can often recover from strokes with better outcomes and prognoses than adults, he said.
“Therapy can be hospital based, outpatient based, school based or community based,” Gee said. “Home programs can be specific exercises for range or strengthening, but also can be used for setting up daily schedules, daily logs for memory, gait and balance, and activities that include returning to community and school.”
Therapeutic advances
Over the years, those who work with pediatric stroke survivors have seen a number of new developments in the field. “There have been many advances in the areas of knowledge of motor control and learning for children, structure of environment for learning, balance, use of resources of constraint therapy, use of adjunctive devices like the Wii, partial weight-bearing training devices using LiteGait or the AlterG anti-gravity treadmill,” Gee said.
At Texas Children’s Hospital in Houston, Lauri Dalton, PT, NDT-trained, has seen the emergence of a variety of new therapies. “Children who previously wouldn’t have survived a stroke are alive today thanks to advances in medicine,” said Dalton, rehab team leader at Children’s, which sees more than 300 pediatric stroke survivors each year. “As a result, we’re starting to see children with more severe injuries and these patients are exhibiting a greater potential for improvement. This puts a greater demand on PTs to do everything possible to make effective change, including a greater incorporation of cutting-edge technology and evidence-based practice.”
There’s a definite need for more PTs to work in this area, Dalton said. “Treatment of a child who has had a stroke differs from that of a child with a congenital diagnosis, such as Down syndrome or cerebral palsy. There is a slightly different focus or approach when you are trying to regain a normal pattern of movement that previously existed, especially in an older child.”
To work successfully with these patients, Dalton said, PTs need training in child development and normal movement patterns. “NDT addresses the dysfunction in posture and movement that are results of a stroke, and works to re-establish normal/typical posture and movement to improve the child’s functional mobility.”
The LegTutor has been effective in rehabilitating children as well as adults after a stroke or other disabling disease. The LegTutor provides a safe and comfortable leg brace with position and speed sensors that precisely record three dimensional hip and 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 rehabilitation system employs the known concept of biofeedback to give occupational and physical therapists access to an affordable user friendly rehabilitation package.The LegTutor together with its sister devices (HandTutor, ArmTutor and 3DTutor) aim to optimize motor, sensory and cognitive performance to allow the patient to better perform everyday functional tasks and improve quality of life. The Tutors are being successfully used in leading U.S. and foreign hospitals and clinics and are suitable for home use through telerehabilitation.