aintaining Strength for Parkinson’s Patients

In an article published in the British Medical Journal, August 23,2012  C.L. Tomlinson et al state that Physiotherapy has only short term benefits in Parkinson’s disease. He further states that there is a wide range of physiotherapy techniques currently in use to treat Parkinson’s disease and that there is little difference in treatment effects. He suggests that there be large, well designed, randomised controlled trials including improved methodology and reporting that are needed to assess the efficacy and cost effectiveness of physiotherapy for the treatment of Parkinson’s disease in the longer term. The methods used to come to this conclusion were: A systematic review and analysis of randomised controlled trials. Literature databases, trial registries, books, and conference proceedings, journals, and reference lists, searched up to January 31, 2012. Randomised controlled trials that compared physiotherapy with no intervention at all in patients with Parkinson’s disease were used. Two authors independently collected data from each trial. Tests for heterogeneity were used. Outcome measures were gait, falls, functional mobility and balance, clinician rated disability measures, patient rated quality of life, adverse events, compliance, and impairment and economic analysis outcomes. The results were: that indirect comparisons of the different physiotherapy interventions found no evidence that the treatment effect was diferent across the interventions for any outcomes assessed, apart from motor subscores on the unified Parkinson’s disease rating scale (in which one trial was found to be the cause of the heterogeneity). Apparently C.L. Tomlinson isn’t aware of the TUTOR system. These physical therapy products, although not a cure for Parkinson’s, have shown that they can maintain the strength of the patient thereby giving him a longer period of mobility. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 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 motion feedback that encourages motor learning through intensive active exercises and movement practice. The HANDTUTOR, ARMTUTOR, LEGTUTOR, 3DTUTOR consist of wearable gloves and braces that detect limb movement showing the patient how much active or assisted active movement they are actually doing. The rehabilitation software uses special rehabilitation games to set a new target for this movement in terms of the patient’s ability to move their limb. The devices then measure the limb movement and give feedback on the success of the patient in trying to gain this new movement objective. In this way the TUTOR system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice. The TUTOR system physical therapy solution is now part of the rehabilitation program of leading U.S. German, Italian, French, UK and other foreign hospitals. As one of the most cost effective PT products on the market the TUTORs can also be used in the patient’s home throughtelerehabilitation. See www.MEDITOUCH.CO.IL for more information.

New Stroke Rehabilitation Device May Join Others Already In Use

Victoria University, New Zealand, masters student in engineering, Abigail Rajendran, 23, designed a stroke rehabilitation device and is working to market it. Rajendran believes that stroke patients will be able to rehabilitate themselves from home with the new device. With the device strapped on to a patient’s hand the goal is to exercise it in an opening and closing motion. A connected computer game activates at the same time and keeps both sides of the brain working. Once the patient regains the strength and can do the motion himself, he can increase the resistance with a special liquid contained in the device. Rajendran says that until now, stroke patients had to rely on expensive and large rehabilitation equipment only found in hospitals. However this device could be used regularly at home. Funding for a prototype has been provided by the Science and Innovation Ministry. Few, if any, home rehabilitation instruments are available for people recovering from strokes and new technology has to be made available according to Chief executive Sunil Vather. Apparently New Zealand stroke patients get only a few hours of therapy if they’re lucky and this device may afford them many more hours. Miss Rajendran will present her idea in Singapore later this month, and in Brisbane in October. The device may be ready for use in about a year. Apparently unknown to Miss Rajendran and her associates such physical therapy solutions already exist and are being used successfully in many leading U.S. and European and other hospitals and clinics. The physical therapy products known as the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been devised to allow intensive exercises to stroke victims as well as those afflicted with disabling Parkinson’s, MS, CP, brain/spinal cord injuries and other upper and lower limb paresis. The TUTORs are comfortable ergonomically designed gloves and braces that are attached to the affected areas of the body and then connected to a computer that has dedicated software in the form of games. These games are played with the active initiation of the patient himself and the results are recorded and evaluated by physical therapists who then design a specific exercise program for that patient. Since many patients have improved to the point where they no longer need hospitalization they and others who live too far from a rehabilitation clinic can avail themselves of the TUTORs at home through the use of telerehabilitation. In addition the TUTOR system is one of the most cost effective physical therapy products on the market today and they are small in relation to hospital based large equipment. The TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

LegTutor the Preferred Therapy for Post Knee Surgery

In Knee Surgery, Sports Traumatology, Arthroscopy, August, 2011 as a clinical article Lee YHD et al. reports that Allograft meniscus transplant is considered as a treatment option for meniscus–deficient patients to provide pain relief and decrease contact stress. This procedure is now considered as safe and reliable for the treatment for knee pain after total menisectomy. This is a new technique that has been developed for arthroscopic meniscus transplant with no bone blocks. It anatomically recreates the meniscus–tibial insertions and provides aperture fixation of the meniscus horns. It is an alternative to the established bone block meniscus transplant technique and is less surgically invasive.
The LegTutor together with its sister devices (HandTutor, ArmTutor and 3DTutor) has proven to be the therapy of choice in leading U.S. and foreign hospitals and clinics for post surgery therapy. The device is beneficial as well for sufferers of stroke, brain and spinal injuries, Parkinson’s disease, MS, CP and other maladys. The LegTutor is a brace that is attached to the leg of the patient and attached to a computer which has dedicated software. The program encourages the patient to move his leg in conjunction with specific games and provides an incentive to move the leg in various directions and thereby to accomplish certain tasks and speed up functional recovery.The system allows the therapist to evaluate, quantify and record the patient’s motor and cognitive impairments. The LegTutor is adjustable to any size and can be used by adults and children alike. Home bound or post recovery patients can use tele rehabiliation for the exercises.

Rehabilitation outcome in traumatic and non traumatic brain injury

In the February edition of Journal of Rehabilitation Medicine http://bit.ly/ig2zcW Dr. Colantonio and his team from the Toronto Rehabilitation Institute analyze data from the Canadian Institute for Health Information’s National Rehabilitation Reporting System on brain injuries, and inpatient rehabilitation treatment outcome. His group found that approximately half of acquired brain injury patients receiving inpatient rehabilitation had non-traumatic causes of brain injury. Traumatic brain injury patients were more likely to be younger, male, from rural areas, and to make greater gains in rehabilitation. Differences were found in the types and numbers of comorbidities. However, patients from these 2 groups had similar lengths of rehabilitation stay.
The HandTutor, ArmTutor and LegTutor system offer the possibility to do intensive massed and motivated exercise practice and are used in both traumatic and non traumatic brain injury patients.

HandTutor eHealth Telemedicine and Tele-Rehabilitation Report

A recent report published by the eHealth Telemedicine community ICT discusses applications in tele-rehabilitation. The report can be found at: http://bit.ly/eeuJgP

The report summarizes tele-rehabilitation as the delivery of rehabilitation services to distant locations, through the use of Information and Communications Technologies (ICT). The report states that the main drive for the introduction of tele-rehabilitation is the need to give specialized therapy to a geographically dispersed population in addition to the need to reduce costs while maintaining or increasing the quality of service. In addition patients that need physically rehabilitation will most probably have mobility issues that make transport to a specialized rehab centre difficult and expensive.

Tele-rehabilitation sessions are more flexible in terms of the timing and frequency of sessions and allow for more follow up on patient compliance and performance when compared to out patient clinic appointments. In addition rehabilitation programs done in the patients home environment have been proven to give better outcomes than equivalent rehabilitation programs conducted in the clinic environment. Up until recently tele-rehabilitation has had two main disadvantages namely, the lack of physical contact between physician and patient and lack of technologies tools that can quantitatively evaluate and treat the patient’s movement dysfunction.

The HandTutor system consists of a glove and software that uses motion feedback sensors to evaluate and treat the patients speed, range and accuracy of hand movements in real time. The dedicated rehabilitation software allows the patient and therapist to monitor and customize the exercise training in real time using readily available remote monitoring and audio and video internet tools to allow for inexpensive virtual physician contact. It is currently being used by patients with hand movement dysfunction in their home environment and is supported by therapists through tele-rehabilitation. http://bit.ly/f6i542

FDA's "Innovation Pathway". How the HandTutor system can teach patients to use a bionic hand

The Food & Drug Administration FDA launches Medical Device "Innovation Pathway". This initiative aims to speed the introduction of breakthrough medical devices. The first project is the brain-controlled, upper-extremity prosthetic. This project follows on from the DARPA-funded prosthetic bionic arm and hand project. The initiative aims to speed the introduction of a military project to create a prosthetic arm http://bit.ly/gv2bmp.
The HandTutor system measures isolated and coordinated finger and wrist movement. The dedicated rehabilitation software allows for movement guidance to show the patient how to move their hand or prosthetic and augmented feedback to show that the prosthetic is moving. A combination of guidance and visual augmented feedback allows for learning motor movement.

Long-term follow-up of botulinum toxin therapy for focal hand dystonia: Outcome at 10 years or more

In the February edition of Movement disorders http://bit.ly/dFTO4n Dr. Codrin Lungu and his team from Beth Israel Deaconess Medical Center Boston USA report on a retrospective study to assess the efficacy and safety of botulinum neurotoxin (BoNT) treatment for Focal hand dystonia (FHD). The group show that BoNT therapy for FHD remains safe and effective after more than a decade of treatment even though the dose of botulinum toxin needed to be increased.
An experienced occupational and physical therapist can reduce spasticity during patient treatments. When the patient has reduced tone they need to improve their level of sensory motor movement ability through intensive isolated and coordinated task practice. When the tone returns post treatment session the patient can continue doing functional tasks and maintain the improved movement ability. The HandTutor, ArmTutor and LegTutor systems allow the patient to do intensive active exercise practice during treatment sessions and have been shown to sustain patient functional improvement post intervention.

Effects of Exercise on Quality of Life in Stroke Survivors (HRQoL)

In the February edition of stroke http://bit.ly/i3MCI2 Dr. Ming-De Chen of Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago USA detail clinical trials that support the use of exercise to improve health related quality of life in stroke survivors. They conclude that the challenge for researchers is identifying effective strategies for sustaining these effects post intervention.
The HandTutor, ArmTutor and LegTutor are upper arm, hand - finger/s wrist and lower extremity rehabilitation systems indicated for patients in rehabilitation centers, private clinics and the home care environment. The home care patient can benefit from tele-rehabilitation. The HandTutor and other Tutor systems use dedicated rehabilitation software that employs motivating games that can be customized to the stage of rehabilitation and the patient’s movement dysfunction. The virtual functional tasks employed ensure that the patient undertakes intensive repetitive active exercise practice with the games being motivating and well tolerated. The HandTutor, ArmTutor and LegTutor systems have been shown to sustain patient functional improvement post intervention.

Isolated, combined and co-ordinated exercise practice improves functional movement ability in spinal cord injury patients

In the February edition of the Journal of Neuro Engineering and Rehabilitation 2011 http://bit.ly/ggKWEw Dr. Angel Gil-Agudo and his group from the Department of Physical Medicine and Rehabilitation, National Hospital for Spinal Cord Injury Toledo Spain report on Gait kinematic analysis in patients with a mild form of central cord syndrome
Central cord syndrome (CCS) is considered the most common incomplete spinal cord injury (SCI). CCS accounts for approximately 9% of traumatic SCIs. It is characterized by disproportionately greater motor impairment in upper compared to lower extremities.
The gait characteristics of subjects with CCS compared with healthy subjects. The gait pattern of CCS patients showed a decrease of knee and ankle sagittal ROM during level walking and an increase in hip abduction to increase base of support.
The HandTutor, ArmTutor and LegTutor systems incorporate the concept of virtual functional tasks. These tasks allow the patient to be given intensive active exercise practice and targeted movement feedback on the position of one, two or more joints. The HandTutor, LegTutor and 3DT Tutor provide both feedback on the patients movement ability and instructions on how to move the joint in association with another joint. This allows the patient to practice isolated and combined movements of the hip and knee and ankle when they work with the LegTutor and 3DTTutor. When the patient works with the HandTutor and ArmTutor system they practice isolated and combined movements of the shoulder, elbow, wrist and fingers. This allows the patient to do intensive task practice that will teach them how to do coordinated movements of two or more joints. Motor learning that teaches the patient how to move more than two joints in a coordinated pattern will improve functional movement ability and the performance of the everyday tasks e.g. walking and reaching.

HandTutor used in tele-rehabilitation

The HandTutor is a rehabilitation glove and software which offers impairment orientated training and augmented feedback. The HandTutor rehabilitates fine movements of the hand and wrist by encouraging and motivating the patient to do active and intensive hand exercises. The device is used in hospitals and community clinics as well as through tele rehabilitation. Examples of patients that are treated include, TBI, stroke, spinal cord injury CP, Orthopedic hand and arm surgery, development co-ordination disorders in children etc.

The HandTutor is available worlwide from clinically trained local representatives www.meditouch.co.il