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

Alternatives to Knee Replacement Surgery

James Jacobsen, 70, knew he would need knee surgery when he saw the x-rays to explain why he was suffering so much pain. It was bone on bone now. But is knee replacement surgery really the only answer? Jacobsen was referred to an orthopedic specialist. At this point he was given information listing the pros and cons of the surgery but also alternative solutions. In this way he could make an intelligent decision about his future. “I’ve got to have my legs under me,” ”I’m not going to have a knee replaced until it’s absolutely necessary” he said. A study published in September 2012 in the journal ”Health Affairs” found that introducing alternative solutions to knee replacement surgery in Seattle led to 38 percent fewer knee replacements, 26 percent fewer hip replacements, and significantly lower costs for the health system during a period of six months. This information is especially important as it comes when there is a phenomenal rise in knee surgeries. There are many factors for this rise: an active population of baby boomers now facing osteoarthritis, growing rates of obesity and the continuing improvement of artificial joints. There has been improved communication between orthopedists and their patients recently to help bring this about. Studies by the Agency for Healthcare Research and Quality and what was published in The Journal of the American Medical Association found that the increase in knee replacement surgery has increased 2.5 times for those middle aged in a period of 10 years and that the surgery for medicare patients has increased 162 percent in 20 years. Osteoarthritis is the major contributor to this phenomenon followed by obesity. Advertisements for artificial joints has also been a factor. However, Dr. John Tierney, an osteopath and orthopedic surgeon based at New England Baptist Hospital and Greater Boston Orthopedic Center, who is one of several doctors recommending a more conservative approach said that he tries to help patients forestall the surgery step as long as possible. Some of those delaying tactics are: losing weight of bariatric surgery to treat obesity, changing lifestyles in order to avoid certain activities, strengthen muscles around the joints and taking pain medication to reduce inflammation. Sometimes there can be a benefit to wearing a brace to offset an unbalanced set of legs. Cortison injections are also an alternative treatment against the joint pain. Since no medication exists yet to counter the progression of osteoarthritis, it is important to remember that artificial joints wear out eventually so delaying the surgery as long as possible makes sense. Dr. David Arterburn, lead author of the Health Affairs study and a researcher at Group Health Research Institute in Seattle, says “…to make sure that patients understand that there is more than one option when it comes to osteoarthritis treatment.” Karen Sepucha, of the Health Decision Sciences Center at Massachusetts General Hospital, says that just because you’re ‘clinically appropriate’ for the surgery doesn’t mean you should have it. To make sure that patients who decide to go through major procedures truly want them, Mass. General now gives patients decision aids for 36 different conditions, including knee osteoarthritis. Being an educated patient is crucial to making the right decision because even physicians will not be able to guarantee success. The LEGTUTOR is a physical therapy product that has a dual function. It can be used prior to knee surgery to strengthen the muscles around the knee joint so that surgery will be more successful, less painful and allow for a more speedy recovery or in fact it may even prevent the need for surgery. Alternatively it can be used as a device to exercise the leg, knee or hip after surgery in order to speed recovery. The LEGTUTOR is an ergonomic wearable leg brace with dedicated rehabilitation software. The LEGTUTOR rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. This means that the LEGTUTOR system allows the physical therapist to prescribe a leg rehabilitation program customized to the patient’s knee and hip movement ability at their personal stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice in the form of challenging games. They are suitable for a wide variety of other neurological and orthopedic injuries and diseases as well as post trauma and orthopedic surgery. The LEGTUTOR is also used by physical and occupational therapists in combination with the HANDTUTOR, LEGTUTOR and 3DTUTOR for upper and lower extremity rehabilitation. The TUTOR system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home supported by telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Innovative Treatments for Spinal Cord Injury Patients

Innovative treatments are needed for individuals with spinal cord injuries (SCI) and can lead to significant functional improvements in patients as well as give them a higher quality of life according to Sue Ann Sisto, PT, MA, PhD, Professor of Physical Therapy, Research Director, Division of Rehabilitation Sciences, Director of the Rehabilitation Research and Movement Performance (RRAMP) Laboratory,Stony Brook University School of Health Technology and Management (SHTM), Studies published in the September 2012 issue of ”Archives of Physical Medicine & Rehabilitation” show that innovative treatments for individuals with SCI can lead to several functional improvements in patients and also a higher quality of life. Dr. Sisto says the findings suggest that a shift in both protocol and policy is needed to advance and standardize rehabilitation for patients with SCI. “These studies provide evidence from many patients that long-term rehabilitation practices such as locomotor training, exercise, and wellness activities for patients with full or partial spinal cord injuries lead to improved health and function in patients,” according to Dr. Sisto. While most of the studies evaluate activity-based rehabilitative practices involving the assessment and the improvement of patients’ neurological or motor functioning, other studies evaluate patients’ overall health status. For example, researchers concluded ( in “Cardiovascular Status of Individuals with Incomplete Spinal Cord Injury from 7 NeuroRecovery Network Rehabilitation Centers,”) that a patient’s resting blood pressure and heart rate are affected by age, body position, and neurological level. They also found that one-fifth of patients had a quick drop in blood pressure because of a sudden position change from lying down to sitting up. Dr. Sisto says that practices like locomotor training, which consists of activities involving step training using body support on a treadmill, and with manual assistance, are valuable and show great promise for motor improvement in chronic spinal cord injury patients. New computer and other technologies, she says, are also helping to improve physical therapy and rehabilitation practices for patients, as well as help professionals more effectively chart patient progress. One of the innovative treatments as is recommended, is a physical therapy solution that is already in use in many leading U.S. and European rehabilitation centers and clinics. Referred to as the TUTOR system the devices are ergonomically designed gloves and braces placed on various affected limbs and then with sensors are connected to dedicated software. The software consists of specially designed games that allow the SCI patient to exercise his hand, wrist, elbow, leg, knee or any other affected limb. Also usable by patients suffering from Parkinson’s disease, MS, CP, stroke, brain injury or other upper or lower limb immobilities the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are physical therapy products that are monitored by therapists who then design a customized exercise program for that patient. The TUTORs are fully certified by the FDA and CE and can be used by adults as well as children from the age of 5. Patients having logistical difficulty or a desire to conduct their rehabilitation from home can do so through telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

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.

The Connection Between Amantadine and TBI

WFTV.COM in FLORIDA reports on Oct. 1, 2012 that Amantadine, the Flu drug, has been effective with improvement in recovery of cognitive skills amongst Traumatic Brain Injury (TBI) victims. TBI is a brain injury caused by a sudden trauma to the brain. This usually is caused by a sports or automobile accident but can occur from other sudden traumas to the head. Sometimes TBI can occur from a brain hemorrhage in which case surgery will be indicated. TBI can be light, moderate or severe in nature and the treatment will vary accordingly. Symptoms can include dizziness, headaches, memory problems, blurred vision, a strange taste in the mouth, vomiting, seizures, slurred speech and more. A loss of consciousness may or may not occur. After stabilization when the proper amount of blood flow, oxygen and blood pressure control is established rehabilitation will have to occur to achieve normal functioning. This rehabilitation will consist of speech therapy, physical therapy, occupational therapy, and social stability. Amantadine has now been used to treat those with consciousness disorders following a brain injury. In a recent test 184 patients who were vegetative or in a minimal conscious state were divided into two groups. One given the Amantadine and the other a placebo. The medication was continued for 4 weeks and then discontinued for 2 weeks. A marked improvement in recovery of cognitive skills occured amongst the amantadine group compared to the placebo. The drug must be actively used to speed recovery, though. The rehabilitation therapy that is part of the recovery of TBI patients should include the most effective physical therapy solutions available. The TUTOR system of physical therapy products is one such set of devices that has proven itself in TBI physical rehabilitation. The newly developed TUTORs consist of ergonomic wearable devices. The HANDTUTOR is a glove for hand therapy and the ARMTUTOR is an arm brace for elbow and shoulder rehabilitation. The LEGTUTOR is a leg brace for leg and hip issues. The system is indicated for patients who have suffered TBI, a stroke, SCI, CP, MS, Parkinson’s disease and other mobility restraining illnesses. It is used by occupational therapists and physiotherapists in rehabilitation centers, private clinics and the home where it can be supported by telerehabilitation. It is designed for those who have head, trunk, upper and lower extremity movement dysfunction. The accompanying software system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. The dedicated rehabilitation software allows the physical and occupational therapist to fully customize the exercises to the patient’s movement ability. In addition, the OT and PT can make objective follow up and reports on their patient’s progress. Rehabilitation aims to 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 TUTORS are certified by the FDA and CE 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.

Decisions, Decisions, Decisions

All the time we read about a famous athlete that sustains an injury and has to undergo surgery as a result of an injury or overuse of an arm , hand or leg. There is always a lingering doubt if that surgery will suspend or cancel the athlete’s playing season or even career. Michelle G. Carlson, MD writes that when a hand surgeon, for example, treats a talented athlete, many questions come up. After the physician makes a diagnosis and decides on a treatment plan, that is often a challenge to any patient but here the questions first begin. When do you treat the patient? Is it possible for the athlete to return to play with that particular injury? Should the treatment wait until the season is concluded? If the decision is to treat immediately, how long a period of time will the athlete be out of play? Is this decision going to end the athlete’s season? or his career? Will being out for the season end his career? How do these questions affect the doctor’s decision? Physicians are expected to make choices where lost days of play can make tremendous differences in the career of collegiate, professional, or even high school athletes. This is why the decisions made should include involving the most sophisticated and advanced methods of treatment so that the athlete has the best chance of returning as fast as possible to his profession. Since most, if not all, limb surgeries necessitate a period of physical therapy during recovery it is imperative for the medical professional to seek out the best physical therapy solution available. Currently that would be the recently created TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are innovative physical therapy products that are speeding the improvement of limb repair in athletes and others who have undergone hand, arm, elbow, shoulder or leg surgery. The TUTORs are comfortable ergonomically designed gloves or braces which are strategically placed on the affected limb and with special sensors connected to dedicated software that detect motion. They provide an intensive exercise program through the use of special games geared to that particular patient . The physical or occupational therapist records and evaluates the patient’s performance and creates a customized program for that patient. In addition the TUTOR system aims to optimize the motor, sensory and cognitive performance of the user. Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE and can be used at the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Recovering From Spinal Cord Injuries

It is very common that spinal cord injury patients will have feelings of fright, confusion or anxiety .They may also have feelings of disbelief because they are still alive even though they have severe disabilities. Actually rehabilitation consists of a multi pronged approach. It includes physical therapies, activities to rebuild skills and emotional and social support. The rehab team of specialists will normally include a physiatrist, recreational therapist, social worker, physical and occupational therapists, nutritionists, nurses, psychologists, case workers to coordinate everything and others. The first part of rehabilitation will consist of the physical aspect of getting the affected mobility returned. This may be accomplished only with the help of devices such as: wheelchairs, braces and walkers. To get the patient to communicate he will use normal typing, writing and phone devices. Muscle strengthening is part of actual physical therapy whereas redeveloping fine motor skills is within the role of an occupational therapist. Basic toileting routines and self grooming are also taught at this stage. If the patient shows the ability to cope, a vocational counselor (VC) will assess skills, dexterity, physical and cognitive capabilities to determine what might be available in terms of employment. The VC will also arrange for any assistive devices that may be needed in the workplace. If the patient will not be able to achieve gainful employment then the VC will find other places for the patient to spend his time in a productive manner. This could include hobbies, educational classes, getting involved in special interest groups, and participating in family and community events. Finally there is recreational therapy which would get the patient to use their abilities to participate in athletic activities at their level. This latter aspect can help to achieve a more normal lifestyle and allow for some raised self esteem. When deciding on the most appropriate form of physical therapy an effort should be made to utilize the most advanced form of physical therapy products. Such devices are now found in the form of the recently developed TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR these devices are at the forefront of assisting spinal cord injury patients to recover lost movement ability skills. The TUTORs implement an impairment based rehabilitation program with augmented feedback and encourage motor learning. The system allows the therapist to evaluate and objectively quantify and record the patient’s motor and cognitive impairments and then customizes a treatment session for that patient. Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE. They are usable by children as young as 5 as well as adults and can be used in the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for further information.

Hip & Knee Surgeries–How to Avoid Them

By now the public knows a lot about and utilizes hip and knee surgery to get a new ”lease on life” when the old joints need replacement. In an article authored by Brent Steepe, a training specialist, on September 5, 2012 he discusses ways to totally avoid the drastic operations and their painful ramifications. Sometimes people who have had those surgeries come to him as the results were not what they were supposed to be or that they are are still in pain. The ”trick” is to determine whether the problem is skeletal or muscular. For this one needs a qualified professional. If the problem is muscular then surgery probably won’t help at all. Having surgery in those cases by inserting metal rods and getting fusions can even cause more pain and other problems. Steepe explains that the problem can be the fact that the rod is inflexible and that it will only force other muscular systems to adapt. Many times a knee replacement is followed by a hip replacement because of that phenomenon. Steepe tells about a woman whose knee joints had become ”bone on bone” and wanted knee surgery. Medications and injections were not helping. Knee replacement was prescribed. She wanted very much to walk and climb stairs pain free. Work was commenced to realign and retrain the muscles on her body so that they would work as designed. After a year and a half she has no pain and can even run. In order to embark on this course of correction the trainer needs to understand the lifestyle of the patient and determine what activities caused the problem in the fist place. Also was the original injury given the proper treatment and attention. Most of the time it turns out that the body part was overused or misused. The next step is to determine where muscle rebuilding needs to take place, what movement patterns need to be changed and what muscles need more support. In that way a plan can be made to alter movements of muscles so that joints can be used in a way that they were intended to move. Then those ”new” positions are reinforced and over time the problem is resolved. The severity of the injury will determine the length of time it will take to solve the problem. Minor problems can be corrected in a short period of time while if a major core muscle group was affected it will take longer. Steepe emphasizes that some previous activities may have to be curtailed or stopped altogether so that the problem doesn’t reoccur. Sometimes all that is needed is to use different muscles and movement patterns. When these non surgical methods are not sufficient and radical surgery is nevertheless needed then during the rehabilitation phase of recovery the patient should avail himself of the most efficient physical therapy solution available. The current trend is to use the TUTOR system of physical therapy products. The LEGTUTOR would be the key component for physical rehabilitation following knee or hip surgery. The LEGTUTOR is an ergonomic wearable leg brace with dedicated rehabilitation software. The LEGTUTOR rehabilitation concept is based on performing controlled exercise rehabilitation practice at a patient customized level with real time accurate feedback on the patient’s performance. This means that the LEGTUTOR system allows the physical therapist to prescribe a leg rehabilitation program customized to the patient’s knee and hip movement ability at their stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice with those that were designed in the form of challenging games. They are suitable for a wide variety of other neurological and orthopedic injuries and diseases as well as post trauma and orthopedic surgery. The LEGTUTOR is also used by physical and occupational therapists in combination with the HANDTUTOR, ARMTUTOR and 3DTUTOR for upper and lower extremity rehabilitation. The TUTOR system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home supported by telerehabilitation. See WWW.MEDITOUCH.CO.IL for more 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.

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.

”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.

Is Knee Surgery Really Needed?

The web is full of articles about knee surgery and how more and more people are opting for this painful solution to osteoarthritis. However a study recently concluded that there may be a way to avoid such an operation completely. A study was conducted in a large military hospital in Texas recently indicating that physical therapy consisting of manual therapy, stretching and strengthening as an exercise regimen may help people with osteoarthritis of the knee avoid a knee joint replacement surgery. During the study, 83 patients with osteoarthritis of the knee were randomly assigned to two groups.The first group of 42 patients received treatment consisting of manual therapy and therapeutic exercise twice a week for four weeks.The second group of 41 patients received a placebo treatment where they received ultrasound in a dosage far below a therapeutic level. The mean age of the partipants was 60 and 62 years respectively. Results were measured at four weeks, eight weeks, and one year post-treatment. The study reports that “Clinically and statistically significant improvements were observed in the treatment group but not in the placebo group”. The study also reports that “the average distance walked in the treatment group was 170 more than that in the placebo group. At one year, patients in the treatment group had clinically and statistically significant gains over baseline in walking distance. While 20 percent of patients in the placebo group had undergone knee arthroplasty, only 5 percent of patients in the treatment group had.” The study concluded with a statement saying “In patients with osteoarthritis of the knee, a combination of manual physical therapy and stretching, range-of-motion, and strengthening exercises may yield improvements in functional ability as well as in subjective measures of pain, stiffness, and function and may delay or prevent the need for surgical intervention. These improvements may persist well after the conclusion of clinical treatment.” When physical exercise is indicated for a problematic knee due to osteoarthritis one of the most effective physical therapy solutions is the LEGTUTOR. The LEGTUTOR consists of a safe comfortable leg brace with position sensors that precisely record three dimensional (3D) hip and knee movements.The LEGTUTOR has a range of motion limiter that can limit the dynamic range of knee extension and flexion. Rehabilitation games allow the patient to exercise Range of Motion (ROM), speed and accuracy of movement. The LEGTUTOR facilitates evaluation and treatment of the lower extremity including isolated and combined hip and knee movements. The LEGTUTOR and its sister physical therapy products (HANDTUTOR, ARMTUTOR and 3DTUTOR) are one of the most cost effective medical devices available for what it accomplishes. Currently in use in leading U.S. and European hospitals and clinics the TUTOR system is fully certified by the FDA and CE and can be used by children as well as adults. They are also available for use in the patient’s home via telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Voluntary Exercises Better Than External Stimuli for Physical Rehabilitation

In the Journal of NeuroEngineering and Rehabilitation, July 2012 edition, Dr.Kyung-Lim Joa of the Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, South Korea published the results of a study in which rehabilitation was evaluated by using voluntary movements as well as Functional Electrical Stimulation (FES). Nineteen healthy male subjects were enrolled in the study. The study design included: a-voluntary contraction only, b-functional electrical stimulation (FES)-induced wrist extension only, and c-simultaneous voluntary and FES-induced movement. Brain activation was observed in all three modes. The activated brain regions (number of voxels) of the MI, SI, cerebellum, and SMA were LARGEST DURING VOLUNTARY CONTRACTION ALONE and smallest during FES alone. SII-activated brain regions were largest during voluntary contraction combined with FES and smallest during FES contraction alone. The brain activation extent (maximum t score) of the MI, SI, and SII was LARGEST DURING VOLUNTARY CONTRACTION ALONE and smallest during FES alone. The conclusions drawn were that voluntary contraction combined with FES may be more effective for brain activation than FES-only movements for rehabilitation therapy. In addition, voluntary effort is the most important factor in the therapeutic process. As it is this is another proof that the patient recovering from and undergoing rehabilitation for affected limbs due to Parkinson’s, CP, MS, stroke, brain or spinal injuries amongst other diseases and surgeries should be using physical therapy solutions that encourage the patient to use his own strength and efforts while exercising more than outside stimuli via robots or electrical impulses. Such physical therapy products can be found in the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been designed for just that type of intensive exercise. Consisting of comforatble and ergonomically designed gloves or braces, The TUTORs improve fine motor, sensory and cognitive impairments through intensive exercises with augmented feedback. The exercises are challenging and motivating and allow for repetitive training tailored to the patient’s own performance. In the case of the HANDTUTOR, for example, the glove has been designed to detect finger and wrist motion and has an open palmar surface to give maximum motor and sensory input. The glove comes in different sizes to allow evaluation and treatment of patients from age 5 and up. One of the most cost effective rehabilitation devices currently in use in leading U.S. and European hospitals the TUTORs are fully certified by the FDA and CE. They can also be used in the patient’s home via telerehabilitaion. 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.

Parkinson’s Disease–Not This Population

In the northern part of Israel and in Syria there is a group of people called ”Druse”. A new study by the University of Haifa and the Carmel and Rambam Medical Centers in Israel has found that the Druse people have a much lower incidence of Parkinson’s disease (PD) than in other populations. In addition it was found that this group suffers less from Essential Tremor (ET). This despite that the Druse tend to intramarry, a fact that usually brings with it higher genetic disease rates. Funded by the Israeli Ministry of Science and Technology the researchers found that the group is a “genetic nature reserve” since they have lived in the same general area for over 1,000 years and do not marry outsiders. Amongst the statistics is the fact that in the rest of the world ET affects an average of 4% of the poulation over 40 and PD an avaerage of 1.5%. The study was conducted with 9000 Druse who were 51 or over and who live in the Galilee section of Israel. Blood samples were taken from those who suffered from any kind of tremor. Of the group only 27 had full tremors and 9 had PD. The researchers were surprised at the low at the low percentage for a group of people that practiced consanguinity (marrying cousins). Normally such a group would be more likely to get PD and ET. A previous survey, though, discovered that genetically 150 different genealogical lines made up the community. This suggested to the researchers that because of so many lines when the community was originally formed it prevented the increase in genetic diseases. For those people who are not part of the Druse population Parkinson’s disease can be very debilitating. Fortunately there are physical therapy solutions that can offer some relief for PD symptoms. At the forefront is the HANDTUTOR. The newly developed HANDTUTOR and its sister devices (LEGTUTOR, ARMTUTOR and 3DTUTOR) have become a key system in neuromuscular rehabilitation and physical therapy for Parkinson’s patients as well as those affected by brain/spinal cord injury and other upper and lower limb disabilities . These innovative devices 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 and intensive training tailored to the patient’s performance and motor, sensory and cognitive movement ability. Customized and simple but powerful rehabilitation software allows the physical and occupational therapist the ability to adjust the program and exercise difficulty to the patient’s movement level. The system also includes objective quantitative evaluations that allow the physiotherapist and his occupational therapist colleagues to report on the patient’s exercise progress. Telerehabilitation features allow the patient to be supported by the physical rehabilitation team when he is at home. This ensures that the patient is motivated to do more practice between treatments by the therapists. The TUTOR system is suitable for children as well as adults. They are certified by the FDA and CE and are available for children as well as adults. See WWW.MEDITOUCH.CO.IL for more information.