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

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

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

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

Evidence for brain recovery following intensive exercise practice

In the January edition of Advances in Brain Recovery and Rehabilitation http://bit.ly/f6wALm Dr. Zorowitz from Department of Physical Medicine and Rehabilitation The Johns Hopkins University School of Medicine, and the Department of Physical Medicine and Rehabilitation, Johns Hopkins USA and Dr. Brainin from Danube University and Danube Clinic, Department Chairman and Director, Department of Neurology Krems Austria discuss discoveries in the past year that have impacted the understanding of brain recovery. The review reports various approaches to neurorehabilitation, and associated evidence that supports post stroke following rehabilitation.
The HandTutor and ArmTutor system is used in both rehab clinic and home care. Evidence shows that intensive active exercise in both acute and chronic stroke patients will improve functional movement ability and quality of life.

Review of the randomized clinical stroke rehabilitation trials in 2009

In the February 2011 edition of Med Sci Monit http://bit.ly/dSnr1h , Dr. Rabadi and his team from Department of Neurology, Veterans Affairs Medical Center, Oklahoma University, Oklahoma City, U.S.A.
present a review of the randomized clinical stroke rehabilitation trials in 2009.
The review details evidence on interventions for motor recovery after stroke that showed improvements in recovery of arm function. These interventions included high-intensity physiotherapy and repetitive task training. Techniques reviewed include constraint-induced movement therapy, electromyographic biofeedback, mental practice with motor imagery, robotics and biofeedback. Exercise programs for community dwelling stroke patient helped maintain and improve the patient’s functional ability and HRQOL.
The HandTutor and ArmTutor system is used in rehabilitation clinic, private OT/ PT and home care settings with proven efficacy for both acute and chronic upper extremity stroke rehabilitation.

The HandTutor system is effective in patients with significant spasticity and or tone

It is possible for an experienced occupational and physical therapist to reduce spasticity for short term during therapy. During the treatment the therapists encourage the patient to do intensive exercise practice. The practice is a combination of task orientated training or task specific training and virtual functional training concentrating on movement impairments (impairment oriented training) e.g. coordination provided by the HandTutor system. This intensive practice will improve the patient’s sensory motor and cognitive movement ability. Thus the aim of the treatment is to allow the patient to have the continued ability to do functional tasks when spasticity returns following treatment. However with high Ashworth score it is not possible to do task specific training. Therefore the HandTutor system allows the patient the possibility to begin to do active exercise training even when they have very limited movement ability. In cases when the patient does not have the ability to open or close his fingers then the therapist can open the patients hand when they feel the patient working with them and not against them.

What are Comprehensive Stroke Centers

January 21, 2011 — The American Heart Association and the American Stroke Association (AHA/ASA) have developed a series of 26 standardized metrics for use by comprehensive stroke centers (CSCs) across the United States to measure and monitor quality of care.

The proposed metrics, and the research backing them, were published online January 13 and will appear in the March issue of Stroke: Journal of the American Heart Association http://bit.ly/haMUSn

Comprehensive stroke centers (CSCs) represent a more intensive level of stroke care than what is available at primary stroke centers (PSCs).
"This is going a step further," said the chair of the paper's writing group, Dana Leifer, MD, associate professor of neurology at Weill Cornell Medical College, New York City. "This is designating certain hospitals with more specialized and advanced methods for treating stroke patients, so patients with more complications or more complicated stroke."

Designating and Certifying Hospitals

Establishing the new metrics is part of an effort to create mechanisms for designating and certifying hospitals in the field of stroke care.

"It's similar to the idea that there are different levels of trauma centers," said Dr. Leifer. "What we are doing in this paper is essentially proposing a standardized set of metrics and other data that CSCs should collect so that the care they provide can be assessed."

In 2005, the Brain Attack Coalition, a joint effort of the AHA and ASA, proposed an infrastructure of personnel, equipment, and protocols for CSCs and called for quality improvement mechanisms and registries to record how patients should be treated. The new recommendations, developed after an extensive review of the literature, are based on experience with previous quality improvement initiatives, such as the Get With The Guidelines (GWTG) program.

Ralph Sacco, MD, president of the AHA and chief of neurology at the University of Miami's Miller School of Medicine and Jackson Memorial Hospital in Florida, said the new recommendations can help provide the basis to monitor and track performance.


Optimal rehabilitation outcome requires customization of intensive repetitive exercises, qualitative assessment and reporting the HandTutor, ArmTutor and LegTutor provide an augmented guidance and feedback exercise program to encourage exercise practice and reduce the dependence on compensatory movement patterns.

Effects of passive-active movement training on upper limb motor function and cortical activation in chronic patients with stroke:

From the archives of J Rehabil Med. 2004 http://bit.ly/gSMcId Dr. Lindberg and his team from Department of Neuroscience, Rehabilitation Medicine, Uppsala University Hospital, Sweden show that chronic patients with stroke with paresis of the upper limb who complete 4 weeks of daily functional exercises improve hand motor function and ability. This was accompanied by changes in cortical activation shown by functional magnetic resonance imaging which suggest reorganization of areas related to movements of the paretic limb.

The HandTutor and ArmTutor system allow for customization of virtual functional tasks. The virtual functional tasks provide the patient with visual guidance on how to complete the task and feedback on their success in completing the task. Guidance and feedback allow for better motor learning and optimization of functional performance outcome.