ArmTutor Assists in Enhanced Rehabilitation following Arthrodesis Surgery

In a study of Poliomyelitis in children which can cause paralysis of shoulder girdle muscles leading to a flail shoulder, Joshua D. Miller, MD et al, in the Journal of Pediatric Orthopaedics:, September 2011 - Volume 31 - Issue 6 - p 679–682, stated that shoulder arthrodesis is indicated as a possible treatment for these children in order to stabilize the shoulder. This retrospective study reviewed all shoulder arthrodesis surgeries owing to complications of polio performed at a major medical institution between 1981 and 1996 to assess position of fusion, radiographic evidence of fusion, complications, and patient satisfaction., Methods: A review of medical records identified 11 patients undergoing 13 shoulder arthrodesis procedures, with a mean age of 14.7 years at the time of the procedure. Internal fixation was achieved with large cancellous screws in 8 patients and a Dynamic Compression Plate (DCP) plate in 5 procedures. Average follow-up period was 41 months. Eight patients were placed into a spica cast and 5 used a sling postoperatively., The results showed that shoulder arthrodesis surgery in this cohort resulted in an average position of fusion with 42.3 degrees of abduction, 23.8 degrees of flexion, and 26.2 degrees of internal rotation. Twelve of the 13 procedures assessed for radiographic union demonstrated fusion. The most common complications were malrotation and nonunion. Of the 13 procedures, 2 underwent humeral osteotomies for malrotation, and 1 with 6.5 mm cancellous screws required revision with a DCP plate owing to nonunion. Six patients underwent hardware removal, 3 of which were specifically owing to complaints of painful hardware. At final follow-up, no patient reported pain and all expressed satisfaction with their results and improved shoulder function after repair.His conclusion was that this study is the largest series of shoulder arthrodesis surgeries for treatment of patients with a flail shoulder from polio to date, providing a more thorough analysis of its efficacy as an indicated treatment., The ArmTutor together with its sister devices (HandTutor, LegTutor, 3DTutor) has proven very effective in improving range of motion of shoulders and elbows following surgery, disease or trauma. The innovative device is an electronic brace connected to a computer with dedicated software. It allows for repetitive exercises to the affected joint with augmented feedback. Currently used in leading U.S. and foreign hospitals the system can be administered by a physical therapist or the patient himself. It is available for children as well as adults and can be used together with tele rehabilitation.

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

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

Rehabilitation using the HandTutor, ArmTutor and 3DTutor prevents compensatory trunk torsion during reaching functional tasks

In the March edition of Brain Research http://bit.ly/eMERcK Dr Johanna V.G. Robertsonlow and Agnès Roby-Bramia from Laboratoire de Neurophysique et Physiologie, Université Paris Descartes, CNRSParis, France and the Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches studied trunk torsion degrees of freedom during reaching movements in healthy subjects and hemiparetic patients. The 3D trunk motion participates in reaching within arm's length in healthy subjects however trunk flexion is increased in stroke patients during reaching movements and the additional degrees of trunk torsion freedom participates in the compensatory strategy in hemiparetic patients.
Rehabilitation using the HandTutor and ArmTutor system incorporates the 3DTutor. Secondary feedback from the 3DTutor is displayed during active reaching movements of the arm. In this way the patient is given augmented feedback on the position and movement of their trunk during the function and is given real time movement guidance on how to reposition the trunk during the functional movement and avoid learning a compensatory movement pattern.

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

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

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

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

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

Effective rehabilitation of older people in a district rehabilitation centre

In the March edition of Journal of Rehabilitation Medicine http://bit.ly/gdpzXF Dr. Inger Johansen and her group from Department of General Practice/General Practice Research Unit University of Oslo, Oslo, Norway assess the outcome of rehabilitation of older patients in a district rehabilitation centre following referral from district hospital, nursing homes or their own homes following stroke, arthrosis, hip fracture and other neurological and orthopedic injuries and chronic diseases. The group found that significant and persisting improvements in activities of daily living were achieved by rehabilitation of older patients with stroke, arthrosis, hip fracture and other chronic diseases in a district inpatient rehabilitation centre with co-ordinated and multi-disciplinary rehabilitation.
The HandTutor and ArmTutor are used in clinic, nursing home and home care to give patients upper extremity arm and hand intensive active exercise rehabilitation and the LegTutor and 3DTTutor allow physical therapists to customize lower extremity rehabilitation exercises that motivate the pateints to achieve optimum rehabilitation outcome.

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

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

Use it or lose it: The HandTutor system enncourages intensive massed exercise practice to regain lost movement ability following stroke

In the past Stroke patients who couldn't use an injured arm or hand were taught to dress and bathe with their good arm. This means the patient was taught a compensatory strategy to achieve the active daily living (ADL) function. This was because until recently scientists thought that when a region of the brain was damaged, its function was lost forever.

However, sophisticated imaging tests of the brain e.g. fMRI have revealed that the brain amazingly can reorganize itself after injury so that when nerve cells die, their functions are taken over by other areas of the brain. This concept is known as neuroplasticity. The concept of neuroplasticity has changed stroke rehabilitation therapy considerably.

"Now we know that if you want to get motor recovery on the affected side, you have to use the affected side—repetitively and intensively," says Richard Zorowitz, M.D., chief of physical medicine and rehabilitation at the Johns Hopkins Bayview Medical Center in Baltimore, Md. "That stimulates the brain to make those new connections."

Neuroplasticity is the principle behind the HandTutor, ArmTutor and LegTutor systems that provide motivating and customized virtual task exercise therapy that allow the patients regardless of their movement ability to do intensive and massed exercise practice.