Complimentary Medicine and Physical Disabilities

A U.S. national survey researching the connection between the use of complimentary medicine and those that have a physical disability produced some interesting results. Matthew J. Carlson, Ph.D. and Gloria Krahn of Portland State University and Oregon Health & Science University conducted the survey, the purpose of which was to estimate the prevalence of complementary and alternative medicine (CAM) as used by the practitioner, assess the reasons for its use, and determine the symptoms for which CAM practitioners were consulted. This was conducted in a national US sample of insured adults with physical disabilities. The methods used were data from a longitudinal survey on a national sample of some 830 adults covered by health insurance who had one of the four disabling conditions: cerebral palsy, multiple sclerosis, arthritis and spinal cord injury. Cross sectional analysis of the data produced estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted. The results showed that CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. The use of CAM was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%). It was used by former devotees (62%) compared to non-users (8%). Spinal cord injury reported the lowest use (14%). The most common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). The common reasons for using CAM practitioners included a lifestyle choice (67%) and also because they are perceived to be more effective than conventional medicine (44%). The conclusions of the survey suggest that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning. Effective treatment of physical disability can also be achieved by obtaining and using the correct physical therapy product. Leading the pack is the TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR these recent innovations have been created to treat physical limb disabilities as a result of a stroke, brain or spinal cord injury, Parkinson’s disease, MS, CP and other upper or lower limb disabilities. The TUTOR system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. Consisting of ergonomicaly designed gloves and braces the TUTORs optimize the patient’s motor, sensory and cognitive performance and allows him to better perform daily functional tasks and thereby improve his quality of life. The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are available at home through telerehabilitation. Fully certified by the FDA and CE the TUTORs can be used by adults as well as children from the age of 5 and up. See WWW.MEDITOUCH.CO.IL for further information.

Ski Accident Statistics and Their Physical Therapy Treatment

Skiing is one of the world’s favorite sports and as such there are a fair amount of injuries to skiers. An analysis of injury statistics compiled over 12 seasons, encompassing 2.55 million skier-days, at a ski resort in Wyoming was used for a ski accident survey. Ticket sales per year was the method of calculating the population surveyed. 9749 skiing injuries were indexed by region and severity according to diagnosis on the initial evaluation. The rates of injury were then analyzed as a function of time. During the 12 seasons the injury rate remained constant at 3.7 injuries per 1000 skier-days. During the study period the rate of lower extremity to upper extremity injury decreased from 4:1 to 2:1 . The ankle injury rate also decreased with time. 7% of all injuries were Ulnar collateral ligament sprains. 30% of all injuries were knee sprains. Anterior cruciate ligament tears increased as a function of time and accounted for 16% of all skiing injuries during the same study period. The most common injury was the medial collateral ligament sprain at 18% of all skiing injuries. In addition there were also forty-seven snowboard injuries recorded. All of the above injuries can be treated by physical therapy products known as the TUTOR system once the patient has been stabilized and is ready for rehabilitation. The TUTORs provide intensive exercise for all upper and lower limb injuries or surgeries. They are also effective for patients who have Parkinson’s disease, stroke, CP, MS, head and spinal cord injuries and other debilitating medical issues. The TUTOR system consists of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. These products include 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 fully certified by the FDA and CE and is currently in use by leading U.S. and European hospitals and clinics. The suystem is available for children from the age of 5 and up and in the home through telerehabilitation.

Stroke Victims and Physical Therapy Gloves

It was reported on Oct. 23, 2012 that a mechanical glove has been devised to aid stroke victims by a Victoria University, New Zealand student. Abigail Arulandu has joined a field that already has physical therapy products such as the HANDTUTOR that have proven success records that achieve the same thing and have been assisting stroke patients for several years. Since most stroke victims have clenched hands as a result of the stroke the purpose of therapy is to get them to expand and reuse the hand. Ms. Arulandu’s device has sensors that measure exerted force as does the HANDTUTOR. The information gleaned is transmitted to physical therapists for analysis. The HANDTUTOR system uses exclusively designed games such as: Snowball, Car race, Bubbles, Asteroid attack and others to challenge the patient in an enjoyable way. These exercises bring the patient to a state where they will be able to function as before the stroke. Arulandu is attempting to emulate known physical therapy solutions for post stroke rehabilitation such as the HANDTUTOR and should be commended for her efforts. The HANDTUTOR is one of several similar products already on the market such as the ARMTUTOR, LEGTUTOR and 3DTUTOR that are available and currently being used in leading U.S. and European hospitals and clinics. The ARMTUTOR is the device of choice for injuries and diseases affecting arm, elbow and shoulder problems. The LEGTUTOR assists patients who have had knee or hip replacement surgery. The 3DTUTOR is a wireless motion feedback device that can be positioned on discrete joints of the head, trunk, upper or lower extremities. This allows for evaluation and treatment of the joint of choice. The 3DTUTOR can be used alone or in combination with the ARMTUTOR or LEGTUTOR to exercise additional interjoint coordination movements. The TUTOR system has also been used to rehabilitate victims of traumatic brain or spinal cord injury, Parkinson’s, CP, MS, Brachial Plexus Injuries and more. All of the TUTORs can be used at home through the use of telerehabilitation and are fully certified by the FDA and CE. Prototypes of new and similar products are fun to create but why duplicate what is effective already? More information about the TUTORs is available at WWW.MEDITOUCH.CO.IL

Weight Training and Exercises for Stroke Patients

Chris Kaiser, Cardiology Editor of ”MedPage Today” reports on ”Working with Weights” for stroke rehab patients. The article is reviewed by Zalman S. Agus, MD; Professor Emeritus , Perelman School of Medicine at the University of Pennsylvania etal. This is a preliminary study of a 6 month study program for combined aerobic and resistance training which resulted in improvements in cognitive function for post stroke patients. The idea was to incorporate resistance training — often overlooked in stroke rehab — that may help improve cognitive skills in stroke survivors. In addition to that aerobic exercise also contributed to improvements in cognition at 6 months, according to Susan Marzolini, BPHE, MSc, of the Toronto Rehabilitation Institute, and her colleagues. Resistance training is not usually a standard component of stroke rehab, according to Marzolini. She stated that “To measure the muscle mass, we used dual-energy x-ray absorptiometry, which is a very precise method. We found that the greater the improvement in muscle mass, the greater the improvement in cognition.” The muscles that were affected most by stroke in this study were those for walking — especially, the hip flexors, which raise the knees up, and the pretibial muscles, which lift the toes up. Many rehab centers have stroke patients only moving their legs, but under the revised program weights are added. The intensity of the amount of weight is the key to their improvement,” according to Marzolini. Marzolini determines the heaviest weight a patient can lift, divides that by half, and then proceeds with 10 repetitions. The reps are then increased gradually. When the patient shows he is ready for more weight, he drops back down to 10 reps. In addition patients also use resistance bands in order to strengthen weak muscles. Resistance training has also added an overall 30% improvement in bilateral strength. Marzolini and her colleagues found an association between positive changes in concentration and attention and aerobic exercise, as it was measured by maximal oxygen consumption. This was independent of time from stroke, sex and change in fat mass and depression score . Forty one patients were studied who suffered a mild or moderate stroke. The mean age was 63, and 70% of the patients used some type of walking assistance. The time from stroke to the start of rehabilitation varied from several months to 5 years. By using the Montreal Cognitive Assessment test, the researchers found that this training program resulted in a significant overall improvement in cognition and specifically in attention and concentration at 6 months following rehabilitation. Marzolini and her team is preparing for stage two of this research, which is a study that randomizes stroke patients to aerobic and resistance training or exclusively resistance training. “I suspect aerobic and resistance training are working synergistically,” Marzolini said. Marzolini feels that exercise is very important for everyone, and especially for stroke patients. Rehab programs should include both strength and aerobic training. In line with the thinking of Marzolini when it comes to exercising limbs that have been affected by strokes the most effective physical therapy products should be used. One of the most efficient such devices currently in use in leading rehabilitation centers worldwide is the TUTOR system. The HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR and 3DTUTOR) has become a key system in neuromuscular rehabilitation for stroke victims as well as for 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 TUTOR products consist of a wearable glove or 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 to the patient. In this way the TUTOR system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice. The TUTORs are fully certified by the FDA and CE and can be used in the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Exercises Following Shoulder Surgery

It is important to have a regular exercise routine following shoulder (or arm) surgery. These will restore normal motion and flexibility and allow a return to work and normal activities. A physical therapist or orthopedic surgeon will probably recommend an exercise program consisting of 15 minutes several times per day. Here are some of the routines that can be followed: (For particular details on the specific exercise search for it by name or speak to your professional). Pendulum, Circular, Shoulder Flexion (Assistive), Supported Shoulder Rotation, Walk Up Exercise (Active), Shoulder Internal Rotation (Active), Shoulder Flexion (Active), Shoulder Abduction (Active), Shoulder Extension (Isometric), Shoulder External Rotation (Isometric), Shoulder Internal Rotation (Isometric), Shoulder Internal Rotation, Shoulder External Rotation, Shoulder Adduction (Isometric), Shoulder Abduction (Isometric). In addition to the above the patient can also avail himself of state of the art physical therapy products such as the TUTOR system. Specifically the ARMTUTOR. The ARMTUTOR™ has been developed to allow for functional rehabilitation of the upper extremity including the shoulder, elbow and wrist. The system consists of an ergonomic arm brace together with dedicated rehabilitation software. The ARMTUTOR™ allows the physical and occupational therapist to report on and evaluate the patient’s functional rehabilitation progress. Intensive repetition of movement is achieved through challenging games set to the patient’s ability. The system provides detailed exercise performance instructions and precise feedback on the patient’s efforts. 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. Telerehabilitation allows the recovering patient to continue his physical therapy at home. The system (which also includes the HANDTUTOR, LEGTUTOR and 3DTUTOR) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See WWW.MEDITOUCH.CO.IL for more information.

Is Telerehabilitation Effective?

To determine the usefulness of telerehabilitation David Hailey etal of the School of Information Systems and Technology, University of Wollongong, Australia reviewed the evidence on the effectiveness of various telerehabilitation (TR) applications. The survey included reports on rehabilitation for any disability, except drug or alcohol addiction or mental health conditions. Considered were all kinds of telecommunications technology for TR. Both study performance and study design were considered . The results were judged on whether each TR application had been successful, whether the results were clinically significant, and whether it was necessary to gather further data to establish whether the application was suitable for routine use. There were 61 scientifically credible studies that reported patient outcomes. Administrative changes were identified through computerized literature searches on 5 databases. Twelve clinical categories were included in the studies. The ones dealing with neurological or cardiac rehabilitation were in the majority. Thirty-one of the studies (51%) were of good or high quality. The study results showed that 71% of the TR applications were successful, 18% were unsuccessful and 11% were unclear as to their status. The outcomes for 51% of the applications seemed to be clinically significant. The poorer-quality studies tended to have outcomes that were worse than those from high- or good-quality studies. The surveyors judged that further study was required for 62% of the TR applications and preferable for 23%. Their conclusion was that TR shows promise in many fields, but evidence of benefit and impact on routine rehabilitation programs is still somewhat limited. There is still a need for more detailed, better-quality studies and for studies on the use of TR in general routine care. One of the areas of success in telerehabilitation is in the use of the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are designed to give intensive rehabilitation exercises to those that have had a spinal cord/brain injury, stroke, Parkinson’s disease, MS, CP, Radial and Ulnar nerve injuries as well as other upper and lower limb surgeries or injuries. The TUTOR system uses sophisticated software that provides a customized exercise program for the individual patient. Many times the patient lives too far from a rehabilitation clinic or has improved to the point where he no longer needs to be seen in a regular clinic. In those cases the TUTORs have an excellent rehabilitation system in place for the therapist to instruct the patient remotely. Currently in use in leading U.S. and European hospitals the TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for further information.

Physical Rehabilitation Through Sports Activities

A division of the U.S. Olympic Committee, the U.S. Paralympics, was formed to become a world leader in the Paralympic sports movement and to promote excellence in those people with physical disabilities. Formed in 2001, U.S. Paralympics has been helping Americans achieve their dreams. U.S. Paralympics is making a difference in the lives of thousands of people with physical and visual disabilities daily through education, sports programs and connections with community organizations, government agencies and medical facilities. There are an estimated 21 million Americans with a physical disability. In recent years, thousands of military personnel have sustained serious injuries during their tour of active duty. Research has shown that daily physical activity improves not only the individual’s self-esteem and peer relationships, it also results in a higher quality of life, increased achievement and better overall health. However most individuals with physical disabilities do not have the opportunity to participate in regular sports activity., That’s why U.S. Paralympics is working hard to make this an important national issue. There are 3 ways in which U.S. Paralympics operates programs. 1) Community Programs. U.S. Paralympics manages many outreach initiatives, that connect with individuals who have physical disabilities directly and supporting Paralympic organizations with program development. A key goal of the U.S. Olympic Committee is to increase the availability of Paralympic sport programming across the country. By partnering with existing organizations, as well as the development of new programs, the U.S. Olympic Committee’s Paralympic Division is targeting 250 Paralympic Sport Clubs in American cities by this year of 2012. USOC Paralympic Military Program. 2) The Paralympic movement was founded through a rehabilitation program developed for World War II veterans that were wounded. In addition, the Paralympic Military Program provides rehabilitation support and mentoring to American veterans who sustained physical injuries. Veterans are introduced to Paralympic opportunities and sport techniques through various clinics and camps. They are also connected with ongoing Paralympic sports programs in their hometowns. The program is not just about sports; it is also about attitude, comaraderie and promoting healthy, active lifestyles. 3) Elite Athlete & Team Support. U.S. Paralympics has been a leader in the preparation and selection of national Paralympic teams for 24 different sports. The athletes represent the U.S. in the Paralympic Games and other international competitions. Another impressive organization that combines the disabled with sport is Israel’s TIKVOT. Tikvot is a non profit volunteer based organization which rehabilitates Israel’s victims of terror through sport. Tikvot means “Hopes” in Hebrew and it has been proven that sport, Tikvot’s tool, provides these heroes with Hope, giving them the power to restore self confidence and dignity. Tikvot operates in tandem with the world’s top specialist organizations with specific expertise in the design of unique sports rehabilitation programs suited expressly to each disability. TIKVOT – brings along the guidance, support and funding for these projects, beginning with the onset of injury and the subsequent period of hospitalization to ultimate rehabilitation on the sports field. When rehabilitation is required for sports or disease related injuries the affected patient should have access to the best physical therapy products available. Such devices can be found in the TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR, The TUTORs have become a key system in neuromuscular rehabilitation for stroke victims and those recovering from sports injuries, brain and spinal injuries, Parkinson’s, MS, CP and other limb movement limitations. The TUTOR products implement an impairment based program with augmented motion feedback that encourages motor learning through intensive active exercises and movement practice. They consist of ergonomically designed wearable glove and braces that detect limb movement showing the patient how much active or assisted active movement they are actually doing. The rehabilitation software uses specially designed games to set a new target for this movement in terms of the patient’s ability to move their affected 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 patient understands which effort is more successful in allowing them to move their affected limb again. The TUTOR system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice. The TUTORs are now part of the rehabilitation program of leading U.S. German, Italian, French, UK and other foreign hospitals. They are available for children from the age of 5 and at home throughthe use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Rehabilitation as a Way to Improve Quality of Life

A journal article authored by R.T. Abresch etal of the Department of Physical Medicine and Rehabilitation, University of California, Davis, . USA discusses how improving quality of life has been a goal of rehabilitation medicine. However, the problem lies in that health care providers often do not know much about the quality of life of individuals that have neuromuscular diseases (NMD), nor what factors will help them to achieve a good quality of life. This lack of knowledge about subjective quality of life factors can bring negatively influenced expectations and the selection of treatments. In the most obvious cases, a physician’s subjective but incorrect assessment of a disabled individual’s quality of life may prevent the patient from receiving life-sustaining interventions. As a group, the quality of life of individuals with NMD is not much different than nondisabled controls and is substantially better than presumed by the general public and, often times, by health care workers. Nevertheless, sometimes their quality of life is reduced in certain areas. Level of disability is not a critical factor that significantly alters life satisfaction, surprisingly. Presumably, this is because physical functioning has been adequately managed. The greatest problems that individuals with neuromuscular disease identified were: lack of information about the disease and services; poor coordination of services; a diminished expectation of their potential and negative attitudes. In addition, people with severe disabilities had significant problems financing, obtaining, and managing personal care attendants. Factors related to a good quality of life were, on the other hand, related to perceived control, perceived health status, but not disability. The more that people could do for themselves, either on their own or with personal care assistants, use of technology, assisstive devices, the better their quality of life. One of the most comprehensive systems to achieve success in rehabilitative medicine is through the use of the TUTOR physical therapy products the results of which will achieve an improved quality of life. Nowadays physical and occupational therapists as well as other health care providers are getting to know that the TUTORs can change not only perceptions but actual outcomes of disability related attitudes. The TUTORs, conisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR, have been created to allow the patient to conduct intensive exercises in a fun way and to derive satisfaction from his successes. Physical therapists monitor the exercises and design a custom made program for that patient. This allows the patient to derive a sense of accomplishment that he himself (and not a robot) has produced and will hopefully lead him to a higher level of independence by performing everyday tasks In addition the TUTORs improve fine motor, sensory and cognitive impairments. The physical therapy products in the form of the TUTORs are ergonomically designed gloves and braces that contain sensors connected to sophisticated software. This software gives the therapist objective and quantitative information on the patient’s functional impairment. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are the preferred physical therapy solution for rehabilitation for patient’s who have suffered a stroke, brain or spinal cord injury, Parkinson’s disease, CP, MS and other upper or lower limb surgeries. Currently the TUTORs are being used in leading U.S. and European hospitals and clinics. They are fully certified by the FDA and CE and are available for children as young as 5 and at the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Exercising for the Heart

Cardiovascular disease around the world is one of great concerns to patients and health providers alike. Cardiac rehabilitation aims to return patients with heart disease to health by exercise-only based rehabilitation or comprehensive cardiac rehabilitation. The Objective of a study on the subject was to determine the effectiveness of exercise-only or exercise as part of a comprehensive cardiac rehabilitation programme on the mortality, morbidity, modifiable cardiac risk factors and health-related quality of life (HRQoL) of patients with coronary heart disease. Electronic databases were searched for randomized trials, using standardised trial filters, for a period of about 10 years. The subject of the trial were men and women of all ages, whether in hospital or in community settings, who had coronary artery bypass graft, myocardial infarction, or percutaneous coronary angioplasty, or who had angina pectoris or coronary artery disease. The studies were selected independently by two reviewers, and data was collected independently. 8440 patient results were analyzed. The results showed that exercise-based cardiac rehabilitation is effective in reducing cardiac deaths. It is not clear from this review whether exercise-only or a comprehensive cardiac rehabilitation intervention is more beneficial. More research will have to be done to determine that.The population studied in this review was still predominantly low risk, male and middle aged. Identification of the ethnic origin of the participants was seldom reported. (It is possible that patients who would have benefited most from the intervention were not included in the trials on the grounds of age, sex or co-morbidity). In plain lamguage it was found that regular exercise or, alternatively, exercise with education and psychological support can lower the likelihood of dying from heart disease. Coronary heart disease (CHD) is one of the most common forms of heart disease. The heart is affected by restricting or blocking the flow of blood around it. This in turn can lead to a feeling of tightness in the chest (angina) or a heart attack. Cardiac rehabilitation tries to restore people with CHD to health through regular exercise or a combination of exercise together with education and psychological support. The findings of this review show that either form of cardiac rehabilitation can reduce the likelihood of death from heart disease. One of the current tested methods of exercise is the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been devised to offer the patient intensive exercises for a variety of ailments. The TUTOR physical therapy products are ergonomically designed gloves and braces that include sensors connected to exclusive, motivating and challenging games. This allows the patient to practice isolated and/or interjoint coordination exercises. The physical therapist then records and evaluates these movements and designs an exclusive exercise program for the patient. The TUTORs are currently in use in leading U.S. and European rehabilitation hospitals and clinics and are also available for home use through telerehabilitation. The TUTORs are usable by adults and children and are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for further information.

U.S. Army Enters Fight …Against Traumatic Brain Injury

It was reported by the Army News Service on August 31, 2012 that the U.S. Army together with the National Football League will be joining to increase the research into the causes, prevention and treatment of Traumatic Brain Injury (TBI). An agreement was reached and signed by Army Chief of Staff Gen. Ray Odierno and NFL Commissioner Roger Goodell to continue sharing their resources to combat TBI. Attending the event were soldiers and players who have had concussions during their service or games. Representatives of the medical corps and 200 cadets also participated. Ironically it is the tough discipline and feeling of team over self that they are taught which prevents soldiers and players from disclosing that they were injured and from seeking help after a concussion. These traits make it difficult for individuals to admit that they have a particular problem, especially mental. Gen. Odierno stated that the goal of the new program is to educate the soldier and player to come forward and be educated that they have to seek treatment both on the battlefield and on the playing field. The general discussed various examples of how dialogue and the sharing of research can monitor TBI. One of the methods is placing sensors in the helmets that are worn that can detect a concussion after a trauma to the head occurs. NFL commissioner Goodell told those assembled that basic cultures (of not disclosing concussions) have to change making players and soldiers share their experiences. The importance of disclosing the incident with officers higher in rank needs to take place without fear of retribution just because they disclosed what happened. Some officers and players told about their personal experiences and how they were reluctant to seek help. The NFL commissioner stated that not asking for help will no longer be tolerated. That there has to be accountability. That coaches and other players will no longer be able to make the decision. Only medical personnell will be allowed to judge whether a player or soldier can return to duty. Proper leadership and supervision includes allowing this to happen. ” Seeking help is playing smart.” he added. Both officials said that enough progress hasn’t been made yet and more needs to be done. There is an Army Directive that stipulates that soldiers have a minimum of 24 hours of downtime and need to get a medical clearance before returning to duty following a blast or vehicle incident. Maj. Sarah Goldman, program director of Army Traumatic Brain Injury at the Office of the Surgeon General, Rehabilitation and Reintegration Division, stated that more than 13,000 service members sustained some form of concussion since 2010 and 95 percent were returned to duty. Odierno, admitted that when he played football he would not have sought medical attention for a concussion. “I wouldn’t have taken myself out. Someone else would have had to.” He said that kind of thinking is wrong. The general added that the army and players have to have a bond to take care of each other no matter what the rank. When TBI occurs the best physical therapy solutions should be put in place. Currently that includes the TUTOR system. Victims of brain injury and stroke can benefit greatly from the Tutor system– the HANDTUTOR, ARMTUTOR, LEGTUTOR and the 3DTUTOR. The Tutor system is being used successfully in leading U.S. and foreign hospitals and clinics and is also benefiting home care patients through the use of telerehabilitation.This ensures that the patient is motivated to do more practice between treatments by the therapists. The newly developed HANDTUTOR and its sister devices have become a key system in neuromuscular rehabilitation and physical therapy for brain injury patients including, post stroke and TBI patients. These innovative physical therapy products implement an impairment based program with augmented feedback that encourages intensive practice and motor learning through active exercises. The exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance , motor , sensory and cognitive movement ability. Customized simple and powerful rehabilitation software allows the physical and occupational therapist the ability to adjust the program and exercise difficulty to the patient’s movement ability. The system also includes objective quantitative evaluations that allow the physiotherapist and his occupational therapist colleagues to report on the patient’s exercise progress. The TUTOR system is suitable for children as well as adults. See WWW.MEDITOUCH.CO.IL for further information.

Ballet: An Art Form or Cause for Rehabilitation

Most of us don’t associate the art of Ballet dance with injury and rehabilitation however ballet is a source of both. There are many causes for such injuries. There may be environmental factors such as faulty dance surfaces. There may be inappropriately fitting footwear leading to foot conditions. There may be spinal cord issues which can be the cause FOR injury as well as a result OF an injury. An incorrect ”turnout” ( the ability of the dancer to turn his or her feet and legs out from the hip joints to a 90-degree position) on the part of the dancer may cause an injury. There may be an inbalance of soft tissue or inadequate quadricep strength. The beautiful but potentially harmful ballet steps of ”plies”-which is a smooth continuous bending of the knees; ”pointe” where the dancer performs steps while on the tips of the toes using a special block shoe and ”demipointe” can all cause serious injury or worse. Both male and female ballet dancers are susceptible to these injuries so when they occur the very best physical therapy solutions need to be at hand during their rehabilitation. Physical and occupational therapists have been using the TUTOR system to rehabilitate injured limbs of patients suffering from strokes, brain/spinal cord and upper and lower limb surgeries, Parkinson’s disease, Cerebral Palsy, Multiple Sclerosis and many other limb disabling medical conditions. It is only natural that the HANDTUTOR, LEGTUTOR and ARMTUTOR would be used in the treatment of ballet injuries as well. The TUTORs are comfortable, ergonomically designed gloves and braces that are strategically placed on the affected part of the body and with sensors attached to dedicated software the patient is subjected to intensive exercises. The therapists evaluate the results and then design a personalized exercise program for that patient. These physical therapy products are currently in use in leading rehabilitation hospitals in the U.S. and Europe. The TUTOR system is fully certified by the FDA and CE and can be used by children as young as 5 as well as adults. Telerehabilitation allows the patient to use the TUTORs in his own home. See WWW.MEDITOUCH.CO.IL for further information.

Making the Case for Continuous Physical Rehabilitation for Parkinson’s Disease Patients

In a controlled clinical trial conducted by Comelia L. Cynthia , MD, Glenn T. Stebbins, PhD, Nancy Brown-Toms, BA and Christopher G. Goetz, MD of the Department of Neurological Sciences, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL. an evaluation was made of the effects of physical disability in moderately advanced Parkinson’s patients following 4 weeks of normal physical activity and 4 weeks of a more intensive physical rehabilitation program. They used a timed motor task and a standard assessment of PD severity (the Unified Parkinson’s Disease Rating Scale [UPDRS] with subscales for mentation, activities of daily living [ADL], and motor function. The test was conducted by an investigator who did not know about the physical rehabilitation status of the patient. Following physical rehabilitation, there was significant improvement in the UPDRS ADL and motor scores, but no change in mentation score. During the 6 months following physical rehabilitation, patients did not regularly exercise, and the UPDRS scores returned to their baseline. The conclusion the researchers reached was that physical disability in moderately advanced PD improves with a regular physical rehabilitation program, but the improvement is not sustained when normal activity is resumed. Parkinson’s disease patients have a physical therapy solution that has shown to be very effective in restoring movement ability to disabled limbs due to the disease. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3 DTUTOR are physical therapy products that are currently being utilized in leading U.S. and European hospitals and rehabilitation clinics. The TUTORs are gloves and braces that are strategically placed on affected hands, arms, elbows, legs and other joints. The sensors in these devices pick up the patient’s movements through dedicated software. Physical therapists monitor, evaluate and design these movements into a customized program for that specific patient. Fully certified by the FDA and CE the cost effective TUTORs are available for children as young as 5 and in the patient’s home through the use of telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Should a Patient Undergo Rehabilitation After Stroke?

Henrik S. Jørgensen, MD etal of the Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark cocnducted a study to determine the value of post stroke rehabilitation. The objective of the study was to evaluate the outcome of stroke divided according to both the severity of the initial stroke and the initial level of disability. The study took place in a stroke unit of a hospital in Denmark that receives all acute stroke patients admitted from a large catchment area of approximately 240,000 inhabitants within the City of Copenhagen. Under normal circumstances acute treatment as well as rehabilitation is cared for within the stroke unit regardless of age, severity of the stroke and premorbid condition. In this study 1197 patients with acute stroke were used. The Main Outcome Measures were: Primary outcome was measured as death, discharge to a nursing home, or to the patient’s own home. Secondary outcome was measured as the patient having neurological deficits and/or functional disabilities after rehabilitation was completed and then again 6 months after the stroke occurred. The indices used were the Scandinavian Neurological Stroke Scale and Barthel . The results were as follows: Stroke was initially very severe in 19% of the patients, severe in 14%, moderate in 26%, and mild in 41% of the patients. Two hundred and fifty or 21% of the patients died during their hospital stay, 177 or 15% were discharged to a nursing home, and 770 or 64% of the patients were discharged to their home. After rehabilitation was completed 11% of the survivors still had severe or very severe neurological deficits, 11% had moderate deficits, and 78% had no or only mild deficits; 20% were severely or very severely disabled, 8% were moderately disabled, 26% were mildly disabled, and 46% had no disability in normal daily activities. The conclusions reached were that there is a great need for stroke rehabilitation in the community and the amount of postrehabilitation disability in stroke survivors cannot be exaggerated. Results, though, should not be used as a guideline for selecting patients for rehabilitation in the acute phase as even the most severe cases experience meaningful improvement during rehabilitation. The question then becomes what is the most effective physical therapy solution that can speed recovery of the affected stroke victim’s limbs. Other than robotic machines which are large and therefore usable only in rehabilitation facilities and hospitals or are cost prohibitive the physical therapy profession has come to know of the effectiveness of the TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR these recently created products are in the forefront of stroke rehabilitation. 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 and 3DTUTOR consist of wearable glove 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 his limb. The devices then measure the limb movement and give him feedback on his success. In this way the Tutor system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice. The TUTOR system is now part of the rehabilitation program of leading U.S. German, Italian, French, UK and other foreign hospitals and can be used at home through telerehabilitation. The TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

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.

”Do Re Me Fa So La” and Physical Rehabilitation

Rehabilitation medicine combined with music therapy has been around for some time now. It as helped people with all kinds of physical disorders and even those affected by Rett syndrome. The benefits of adding music, an art, to a physical maneuver is unique and successful.Numerous studies have shown how physical therapy results are enhanced by adding music in the background or having the patient directly involved in creating the music. The music is actually ”instrumental” in physical recovery and health maintenance. One of the beautiful benefits of using music during physical rehabilitation is that one can witness the active and consistent participation of the patient which is often not the case with standard rehabilitation. The music itself encourages participation in exercises. It can also relieve the discomfort associated with the activities. It is the goal of regular music therapy to get the participant to express himself through the music so the common goal here is to alleviate symptoms of orthopedic, pediatric and neurological conditions in order to improve range of motion, strength, communication, balance and cognition and generally the quality of life. Occupational therapists are finding that music therapy assists clients to maximize the patient’s independence in their daily roles. When accompanying music is used in conjunction with physical rehabilitation it would be the ultimate combination if the physical therapy products in use were of the highest quality and most efficient. Such would be the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. These recently created devices are comfortable ergonomically designed gloves and braces that are strategically placed on affected limbs and through sensors are connected to sophisticated software. The software consists of exclusively designed games that the patient plays. Physical therapists monitor , record and evaluate the patient’s progress and design a specific exercise program for the patient. The patient himself activates the limb rather than an external robotic device that causes movement. In that way the patient has control and can progress further independently. The TUTOR system has been in use now for some time in leading U.S. and European hospitals and rehabilitation clinics. The TUTORs are fully certified by the FDA and CE, are available for children as well as adults and can be used at the patient’s home through the use of telerehabilitation. 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.

New Formula Predicts Rehabilitation Outcome

The journal called ”Brain” featured an article on July 31, 2012 about a development that could revolutionize rehabilitation for stoke patients. University of Auckland researchers have shown how it may be possible to predict potential recovery in stroke patients for hand and arm function. Realistic goals for recovery may be set for patients and trial outcomes for new therapies may have also have better results through this approach. According to Professor Winston Byblow one of every six people will have a stroke at some time during their life and until now comparisons were made as to outcome based on group similarity to others with the same symptoms. An individual patient’s rehabilitation plan can not be known. ”We have developed the first clinical algorithm to actually predict the individual patient’s potential for recovery based on information gathered before rehabilitation even begins.” said Byblow. A test is administered to the hospitalized stroke patient within 3 days of the event. It is very quick and requires no special equipment. Dr Cathy Stinear, who authored the journal article, explains that in some cases additional testing may be required such as an MRI to determine whether the pathways in the particular side of the brain remain viable and to measure the integrity of neural pathways from the brain to the arm. When the algorithm is combined with the results of the tests a prediction can be made about patient recovery at 12 weeks which is when therapy would normally end. The information gleaned from this new test can be used to customize rehabilitation for the patient before it even begins. It is the first study to predict an individual’s potential for motor function recovery using test results obtained from that patient in the first days after stroke, according to Neurologist Professor Alan Barber, a member of the research team and Head of the Auckland Hospital Stroke Service . The research team is now in a three year trial period of the algorithm method to show if the outcomes really benefit the patient and increases the efficiency of hospital rehabilitation services. Once that prediction is made and actual rehabilitation commences the physical therapy product of choice may well be the HANDTUTOR and ARMTUTOR. The HANDTUTOR and ARMTUTOR™ have been developed to allow for functional rehabilitation of the upper extremity including the shoulder,arm, elbow and wrist. The system, recommended for use for a variety of injuries and diseases including stroke, Parkinson’s, CP, MS and other upper and lower limb disabilities , consists of an ergonomic wearable glove and arm brace together with dedicated rehabilitation software. The TUTOR systems (including the LEGTUTOR and 3DTUTOR) allow the physical and occupational therapist to report on and evaluate the patient’s functional rehabilitation progress. This allows them to prescribe the correct customized and motivating intensive exercise practice to the manual rehabilitation therapy. Intensive repetition of movement is achieved through challenging games set to the patient’s ability. The system provides detailed exercise performance instructions and precise feedback on the patient’s efforts. 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. Telerehabilitation allows the recovering patient to continue his physical therapy at home. The system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See WWW.MEDITOUCH.CO.IL for more information.

First Use of Hand At Age 12

It has just been reported that Kyril, a 12 year old boy from Latvia can now do anything he wants with his right hand for the first time in his life. Kyril is one of a rare group of children that suffered from Brachial Plexus Palsy, a defect that occurs in one in 3-5,000 births that prevents normal movement of the hand. Most children learn to cope with it and 90 percent of them eventually are fine as the disability passes by 3 months of age. With Kyril it didn’t and he was sent to Israel where Dr. Mark Edelman, a pediatric orthopedist and the head of the pediatric orthopedic department at Rambam Medical Center in Haifa, operated on him and ”rearranged” his wrist and shoulder bone. In addition to that miracle Kyril was able to leave the hospital after only one day as the operation precluded the need for a plastic cast and other treatments. For others who are not so lucky and are suffering from Cerebral Palsy and other disabling diseases getting the right type of physical therapy solution is critical in order to restore normal movement in the affected limb. Such a solution can be found in the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been included in physical therapy programs at leading U.S. and European hospitals and rehabilitation facilities. These devices are ergonomically designed gloves and braces that have sensors to detect even the slightest movement on dedicated software they are connected to. The physical therapists then record and quantify this information and design a customized intensive exercise program with augmented feedback leading to enhanced rehabilitation for the patient. The TUTOR system is suitable for children as well as adults and can be used at the patient’s home through telerehabilitation. The TUTORs are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

Dolphin Assisted Therapy (DAT) and Cerebral Palsy

Dolphins have been used to treat a variety of ailments including autism, cerebral palsy, trauma and cancer among other disabilities. Dolphin-assisted therapy (DAT), as a part of animal-assisted therapy and complementary and alternative medicine, yields several positive results. A study in the Ukraine called ”Dolphin Swim” used 37 participants who were parents of special needs children. The children suffered from a variety of diagnoses which included emotional and physical disorders. Five treatment programs took place over a span of 2 weeks. A comparison was made with pretreatment and post treatment using DAT (Dolphin Assisted Therapy). The results showed positive behavioral changes in the affected children. In Israel at the Eilat Dolphin Reef Dr. Ilan Kutz of the Meir Medical Center has supervised the unusual treatment and rehabilitation of trauma victims. DAT is not a cure but alleviates symptoms significantly. Dolphins are very intelligent creatures and have a language of clicks and physical movements. They enjoy communicating with humans and like to be touched, petted and cuddled. The mammals react to the person if they feel a connection to him and then they will give unconditional love. In a particular case of a young man that was severely beaten and even after his physical wounds were healed he didn’t speak. Working with the Dolphins greatly improved his swimming skills and he now speaks normally. Aside from this unusual therapy the CP patient can hope to improve limb movement ability with the use of the TUTOR system. This most cost effective physical therapy solution (as is the dolphin therapy) is currently used in leading U.S. and European hospitals and clinics. The system which includes the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomic wearable devices together with powerful dedicated rehabilitation software. The TUTOR system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. The physical therapist can then record and design a custom made exercise program for that particular patient’s needs. The Tutors are also available for adults and children and can be used in the patient’s home through the use of telerehabilitation. They are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

U.S. Congress Passes Bill to Allow More Technology for Disabled Individuals

The following is a portion of a new bill that recently was passed by the U.S. congress to allow more access to rehabilitation devices through Medicare. A BILL To amend title XVIII of the Social Security Act to provide for coverage and payment for complex rehabilitation technology items under the Medicare program. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the ‘Ensuring Access to Quality Complex Rehabilitation Technology Act of 2012’. SEC. 2. FINDINGS. Congress finds the following: (1) Individuals with disabilities and significant medical conditions such as Cerebral Palsy, Muscular Dystrophy, Multiple Sclerosis, Spinal Cord Injury, Amyotrophic Lateral Sclerosis, and Spina Bifida experience physical, functional, and cognitive challenges every day. (2) Complex rehabilitation technology items (CRT items), including products such as complex rehabilitation power wheelchairs, highly configurable manual wheelchairs, adaptive seating and positioning systems, and other specialized equipment, such as standing frames and gait trainers, enable individuals to maximize their function and minimize the extent and costs of their medical care. (3) Access to CRT items and related services can be threatened by inadequate coding, coverage, and payment policies for such items and services. These policies have restricted access to existing complex rehabilitation technology and stifled innovation. Access challenges have increased over the past several years and, without meaningful change to these policies, will only become greater in the future. (4) Current Medicare policies often fail to adequately address the needs of individuals with disabilities, to consider the range of services furnished by complex rehabilitation technology suppliers, and to recognize and account for the complexity and unique nature of the equipment itself. (5) A significant factor responsible for such access challenges is that individually-configurable CRT items do not have a distinct payment category under the Medicare program, but instead are classified within the broad category of durable medical equipment (DME). CRT items serve patients with serious medical conditions that require a broader range of services and specialized personnel than what is required for standard DME. Customizable CRT items also require more resources in the areas configuring, training, and education to ensure appropriate use and to optimize results. (6) Unlike most DME, a medical model incorporating an interdisciplinary team approach is necessary to ensure proper customization and use of a CRT item. This team typically includes a physician, a licensed physical or licensed occupational therapist (with no financial relationship with the CRT supplier), a qualified CRT professional, the individual using such item, and sometimes a caregiver for such individual. (7) The Medicare program should recognize the specialized nature of the CRT service delivery model, the required supporting processes and technology-related CRT services, the credentials and competencies needed by the providing suppliers and critical staff, and the related costs involved. A separate benefit category for CRT items would allow for unique coding, coverage, and payment rules and policies that address the unique needs of persons with disabilities and acknowledge the extensive service component. The TUTOR system is one of the most cost effective and useful physical therapy products now being used successfully in leading U.S. and European rehabilitation hospitals and clinics. Fully certified by the FDA and CE the devices are known as the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. These products are ergonomic gloves and braces that are connected to custom made powerful software that givers the therapist objective and quantitative information on the patient’s functional impairment. The information is then recorded and allows the therapist to fully customize the treatment session. The treatment consists of intensive customized exercises with augmented feedback leading to enhanced functional rehabilitation. The TUTOR system is available for children and adults and can be used at the patient’s home, if necessary, through tele rehabilitation. See WWW.MEDITOUCH.CO.IL for more information.