http://handtutorblog.wordpress.com/2011/08/25/armtutor-successful-in-post-shoulder-therapy/

Dr. Kiyohisa Ogawa writing in the Journal of Trauma-Injury Infection & Critical Care, 17 August 2011 explains that the majority of type I coracoid fractures set out in Ogawa’s classification constitute double disruption of the superior shoulder suspensory complex (SSSC) as proposed by Goss, frequently resulting in healing delay and adverse functional consequences. However, there are few reports alluding to strategies or concrete treatment methods of such injuries. The purpose of this report is to introduce our surgical strategy for treating the type I coracoid fracture with concurrent injuries and to describe our treatment method with their outcomes.
The methods used: Thirty-six patients, who had acute type I coracoid fractures surgically treated and were followed up for 1 year or longer, constituted the present study population. Reduction and stabilization were undertaken beginning with the most medial unstable injury of SSSC and proceeding to the lateral ones. The respective coracoid fractures were finally reduced and fixed. In the follow-up, patients were directly examined and evaluated using the ratios of the Constant score for the injured side to that for the normal side.
The results were: There were a total of 80 ipsilateral injuries of SSSC, including the coracoid fractures, and double disruption accounted for 94% of the patients. Of these, 62 injuries were surgically treated. No complications associated with surgery were observed. Bone union was achieved in all fractures; no patients required an additional operation. The Constant score ratio at the follow-up was 93% +/- 7.4% on average.
The conclusionwas : Although the majority of cases with type I coracoid fractures suffered double disruptions of SSSC, satisfactory results have been obtained with surgical treatment focusing on the assured reconstruction of a firm scapuloclavicular union.
Following shoulder surgery as well as other traumas the ArmTutor has proven to be a success in improving fine motor, sensory and cognitive impairments through intensive active exercises. Repetitive training tailored to the patient’s performance includes augmented feedback leading to enhanced functional rehabilitation. The ArmTutor and its sister devices the HandTutor, LegTutor and 3DTutor are being used in leading U.S. and foreign hospitals and clinics. The system is adaptable to both children and adults and allows for tele rehabilitation for patients at home.

HandTutor eHealth Telemedicine and Tele-Rehabilitation Report

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

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

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

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

Interprofessional community-based stroke rehabilitation superior to usual care in acute stroke

In the February edition of The Canadian Journal of Neurological Sciences http://bit.ly/hPd1fE Dr. Markle-Reid and her team from Master University, Hamilton, Ontario, Canada compared an interprofessional stroke rehabilitation approach to usual care in 82 acute post 18 months community-based stroke rehabilitation patients. The primary outcome was change in health-related quality of life and functioning. The group found that stroke survivors in the intervention group showed clinically important improvements in physical and social functioning scores. Although there was a higher total per-person costs of use of health services in the intervention group compared to usual home care the difference was not statistically significant. The Canadian group concluded that a specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care.
The HandTutor and ArmTutor for upper extremity arm and hand rehabilitation and the LegTutor and 3DTutor systems for hip and knee lower extremity rehabilitation incorporate the concept of virtual functional tasks which are used to motivate the patient to do intensive active exercise practice are used by the patient in clinic and at home with home care patients being supported by tele-rehabilitation.

Home Care stroke patients achieve similar outcome walking results to in clinic patients

National Institutes of Health steering committee shows that stroke patients who had a home physical therapy exercise program improved just as well as those who did the locomotor training.
Results from the LEAPS Locomotor Experience Applied Post Stroke Trial presented were presented by Dr. Bruce Dobkin at the American Stroke Association's International Stroke Conference 2011 in Los Angeles. The study funded primarily by the NIH's National Institute of Neurological Disorders and Stroke, with additional support from the National Center for Medical Rehabilitation showed that at an home walking exercise program achieved similar gains to a body-weight supported treadmill program.
The body-weight supported treadmill training and home based walking practice was started at two different stages, either two months after stroke or six months after stroke with the early intervention group achieving better functional gains. Outcome measures used included speed and distance of the patients walking, their physical mobility, motor recovery and social participation and improvement in quality of life. It was further concluded that the at home exercise program supported by a physical therapist required less expensive equipment, less training for the therapists and fewer clinical staff members.
"We were pleased to see that stroke patients who had a home physical therapy exercise program improved just as well as those who did the locomotor training,'' said LEAPS principal investigator Pamela W. Duncan, a professor at Duke University School of Medicine and a former student of Dobkin's. "The home physical therapy program is more convenient and pragmatic. Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life."
The LegTutor and 3DTutor systems incorporate the concept of virtual functional tasks which are used to motivate the patient to do intensive active exercise practice. The LegTutor can be used by patients who can not support their body weight as well as by patients doing closed chain standing exercises. The LegTutor and 3DTutor provide both feedback on the patient’s movement ability and instructions on how to move the joint in association with another joint thus allowing for exercise training without the patient adopting compensatory movement patterns. This allows the patient to practice isolated and combined movements of the hip and knee and ankle when they exercise with the LegTutor and 3DTTutor. The system can be used by the patient in clinic and at home with home care patients being supported by tele-rehabilitation.