The HandTutor assists recovery of upper limb dexterity in stroke patients

In the April edition of NeuroRehabilitation http://bit.ly/jCIipo Dr. Kong and his group from Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore look at the arm and hand functional ability of one hundred and forty patients more than a year after stroke onset. The group found that upper extremity functional deficit was present in almost 70% of patients with chronic stroke. The lack of functional ability correlated to upper limb strength and spasticity. The group concluded that the most significant predictor of dexterity, functional outcome and quality of life was the severity of upper limb paresis on admission to rehabilitation.
The HandTutor is used in both acute and chronic hand and arm rehabilitation by occupational and physical therapists based both in hospital and outpatient clinics.

The HandTutor system is being used to treat MS patients and the virtual task practice trains motor, sensory and cognitive movement impairments.

In the April edition of the J Int Neuropsychol Soc http://1.usa.gov/j8GFjG Dr. Benedict and his team from Buffalo School of Medicine, Department of Neurology, and the Jacobs Neurological Institute, Buffalo, New York found that processing speed and executive function tests were significant predictors of lower and upper motor function in both healthy and Multiple Sclerosis (MS) patients. The cognitive tests predicted variability in motor function after controlling for disease duration and physical disability which has implications for risk assessment and treatment of mobility dysfunction in MS.

Exercising isolated and coordinated hand movment impairments using the HandTutor improves functional movement ability

In the April edition of Journal of NeuroEngineering and Rehabilitation http://bit.ly/iLXFlB Dr. Carpinella and her team from LaRiCE: Gait and Balance Disorders Laboratory, Department of Neurorehabilitation, Milan, Italy compared spatial and temporal aspects of hand movement in 12 healthy volunteers and 14 hemiplegic stroke survivors.
The group found that in comparison with healthy controls revealed that hemiparetic hand movement was impaired not only in joints ROM but also in the temporal aspects of motion: peak velocities were significantly decreased, inter-digit coordination was reduced of more than 50% and inter-joint coordination patterns were highly disrupted.
The HandTutor system trains isolated and coordinated hand movement impairments in a motivating and challenging environment that promotes exercise practice in order to better achieve functional hand movement ability so that the patient can better perform everyday living tasks.

HandTutor and LegTutor system used in patietns with incomplete spinal cord injury

In the April edition of Neurorehabil Neural Repair http://bit.ly/ejZmRc Dr. Kelly Brunton and his team from the University of Alberta, Edmonton, AB, Canada research objective measures of functional walking in individuals with incomplete spinal cord injury. The group discuss The Spinal Cord Injury Functional Ambulation Profile (SCI-FAP) which was developed to address the need for a measure of functional walking in the spinal cord-injured population. The SCI-FAP involves the timed performance of seven common walking tasks, such as walking and negotiating obstacles, doors and stairs. The measure accounts for manual assistance and walking aids used. In this study the group show that the SCI-FAP has high inter-rater and test-retest reliability, as well as discriminative and convergent validity.
The LegTutpr and 3DTutor can be used to provide intensive lower extremity virtual functional exercise practice. The LegTutor uses a dedicated rehabilitation software that uses motivating games that can be customized to the stage of rehabilitation and the patients movement. The LegTutor encourages both open and closed kinetic loop active exercises.

HandTutor used with mental practice to improve hand movement ability

Mental practice or movement imagination is a training method where the patient imagines a movement without actually moving the limb that has movement dysfunction. Recently researchers have proposed the use of mental practice to facilitate motor recovery in stroke patients and other patients with motor disorders. Mental practice is the imagined rehearsal of a movement with the specific intent of improving that movement and it is suggested that during mental practice the motor control structures in the brain are activated in more or less the same way as during the actual performance of movements. This mechanism of improving limb movement has been reinforced by neuroimaging studies taken during motor imagery and show that the same brain areas are active as during actual movement. In addition, studies with healthy individuals have shown that motor imagery and actual action share some striking similarities. When someone is asked to perform a movement, for example, “walk along this line”, and to imagine the same movement, the time to complete the actual walking movement is similar to the time needed for completing the imagined walking movement.

HandTutor, ArmTutor system improves functional movement outcomes

In the April edition of The Journal of Bone and Joint Surgery (American) http://bit.ly/iiSMgj Dr. Smitherman and his group from Department of Orthopaedic Surgery, Greenville Hospital System University Medical Center, 701 Grove Road, USA investigated the functional outcomes, following single-event multilevel surgery of the upper extremity in children with hemiplegic cerebral palsy. The group found that children with hemiplegic cerebral palsy showed significantly improved dynamic segmental alignment and, to a lesser degree, spontaneous use of the upper extremity following single-event multilevel surgery compared with a comparable nonoperative control group. However, the grasp-release ability did not significantly improve in either the operative or nonoperative group.
The HandTutor and ArmTutor system is used to train patients through intensive exercise practice to use their impaired arms and hands and improve their functional movement ability.

HandTutor system increases the dose of exercise training in order to improve functional hand movement ability

In the April edition of Neurorehabilitation and Neural Repair http://bit.ly/gXjd8x Dr. Anthony Rudd Consultant Physician in Stroke Medicine St. Thomas' Hospital London and Professor of Stroke Medicine King's College London discuss a study looking to find the optimum Dose–Response of Mobilisation and Tactile Stimulation Therapy for the Upper Extremity Early After Stroke. The group state that Physical therapy doses may need to be higher than provided in current clinical practice, especially for patients with severe paresis.
The HandTutor system allows the patient to undertake motivating and challenging active intensive exercise practice. It is suitable for patients with severe movement impairments as well as patients that need to improve their fine motor movement ability. The HandTutor system is used in acute, sub acute and outpatient treatments. The HandTutor system is also used by the patient at home and can be supported by telerehabilitation. This allows for an optimum and higher dose of exercise training.

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.

Community-based upper-extremity rehabilitation improves motor function and performance of functional activities in chronic stroke

In the Arch Physical Medical Rehabilitation http://1.usa.gov/hAQpOz Dr. Pang and his colleagues from School of Rehabilitation Sciences, University of British Columbia, Rehabilitation Research Laboratory, GF Strong Centre, Vancouver, BC, Canada assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke. The patients underwent an exercise program designed to improve upper-extremity function (1h/session, 3 sessions/wk for 19wk). The group found that community-based exercise program can improve upper-extremity function in persons with chronic stroke.
The HandTutor and ArmTutor system is proven to improve upper extremity function in pateints with arm movement dysfunction in both rehabiliation clinic and the home.

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.

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.

Restoring near-natural arm, hand and finger function to patients suffering from spinal cord injury, stroke or amputation

On Feb. 8, The Food & Drug Administration unveiled a new, fast-track protocol for breakthrough medical technologies this week, saying its new "Innovation Pathway" aims to speed high-tech devices to market.

Projects tapped for the innovation program would have to be "truly pioneering" and capable of "revolutionizing patient care or healthcare delivery" to be eligible. Those tapped would receive roadmap and timeline from the Center for Devices & Radiological Health (CDRH) for the development, testing and review of the device. An FDA "case manager" would be assigned to each project, to help identify and address "important scientific issues" early on.

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.