Children Benefit From Tutor System After Stroke

Linda Childers writing in PT.com on September 19, 2011 tells this story.
It’s early morning when Teresa Gill, PT, walks into her patient’s room, introduces herself, and explains how they will work together to overcome the gait problems and muscle weakness that her patient sustained due to a recent stroke. Gill’s patient isn’t a spry octogenarian, but rather a 6-year-old girl who wants to know when she will be able to play soccer again. Each year, about 4,000 children in the U.S. experience a bleed or blockage of the blood flow in their brain that characterizes a stroke, according to the American Heart Association. Certain conditions such as congenital heart problems, arteriovenous malformations, hemophilia and sickle cell disease also can cause stroke in children.
While the vast majority of strokes occur in those older than 65, U.S. Centers for Disease Control research presented at the International Stroke Conference in Los Angeles this past February, showed that ischemic strokes are increasing among children and younger adults. Between 1995 and 2008, hospitalizations among those ages 5 to 14 increased 31%, from 3.2 per 10,000 to 4.2 per 10,000. Among those ages 15 to 34, hospitalizations increased 30% from 5 per 10,000 to 6.5 per 10,000, researchers found.
Although this study didn’t explore reasons for the trend, CDC researchers point to increased childhood obesity — which can lead to risk factors including heart disease and diabetes — as well as better diagnoses using MRI as likely factors.
Team push
For physical therapists such as Gill, who works at Children’s Hospital in Oakland, Calif., treating childhood stroke survivors involves serving as part of an interdisciplinary team that works to help children relearn their motor skills. This often means working with infants who have suffered a stroke in utero. “We are fortunate enough to have physical therapists here at Children’s who work with patients in the neonatal intensive care unit and pediatric intensive care unit as soon as they are medically stable,” Gill said.
While infants may not show signs of deficits immediately after a stroke, effects often become apparent as they grow older. Four of five newborns who experience a stroke around the time of birth develop neurologic disorders such as cerebral palsy or epilepsy, according to the American Stroke Association. “Treatment time and the frequency of physical therapy sessions depend upon the severity of a child’s injury,” Gill said. “Recovery can range from acute inpatient physical therapy to acute intensive rehabilitation, and often includes outpatient physical therapy. A typical inpatient course can last between six to eight weeks; outpatient physical therapy may continue for years as the patient continues to make gains.”
Symptoms, severity
While some children recover under a physical therapy regimen after sustaining a stroke, others suffer long-term residual effects. “Because [deficits in] children with strokes can be multifaceted, neurorehabilitation includes many different therapies to help children regain the use of their brain function,” said Richard Gee, PT, of Lucile Packard Children’s Hospital in Palo Alto, Calif. “The therapies focused for pediatric stroke patients are specific for the symptoms that are present secondary to the stroke, and are also age specific to the child.”
Gee said that symptoms he encounters with pediatric stroke survivors include spasticity; decrease in range of motion; weakness; paralysis; speech, language and communication problems; aphasia; hemiparesis; neglect of the affected side; decreased vision; dysphagia; and swallowing difficulties. Because their brains are still developing, children can often recover from strokes with better outcomes and prognoses than adults, he said.
“Therapy can be hospital based, outpatient based, school based or community based,” Gee said. “Home programs can be specific exercises for range or strengthening, but also can be used for setting up daily schedules, daily logs for memory, gait and balance, and activities that include returning to community and school.”
Therapeutic advances
Over the years, those who work with pediatric stroke survivors have seen a number of new developments in the field. “There have been many advances in the areas of knowledge of motor control and learning for children, structure of environment for learning, balance, use of resources of constraint therapy, use of adjunctive devices like the Wii, partial weight-bearing training devices using LiteGait or the AlterG anti-gravity treadmill,” Gee said.
At Texas Children’s Hospital in Houston, Lauri Dalton, PT, NDT-trained, has seen the emergence of a variety of new therapies. “Children who previously wouldn’t have survived a stroke are alive today thanks to advances in medicine,” said Dalton, rehab team leader at Children’s, which sees more than 300 pediatric stroke survivors each year. “As a result, we’re starting to see children with more severe injuries and these patients are exhibiting a greater potential for improvement. This puts a greater demand on PTs to do everything possible to make effective change, including a greater incorporation of cutting-edge technology and evidence-based practice.”
There’s a definite need for more PTs to work in this area, Dalton said. “Treatment of a child who has had a stroke differs from that of a child with a congenital diagnosis, such as Down syndrome or cerebral palsy. There is a slightly different focus or approach when you are trying to regain a normal pattern of movement that previously existed, especially in an older child.”
To work successfully with these patients, Dalton said, PTs need training in child development and normal movement patterns. “NDT addresses the dysfunction in posture and movement that are results of a stroke, and works to re-establish normal/typical posture and movement to improve the child’s functional mobility.”
The LegTutor has been effective in rehabilitating children as well as adults after a stroke or other disabling disease. The LegTutor provides a safe and comfortable leg brace with position and speed sensors that precisely record three dimensional hip and 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 rehabilitation system employs the known concept of biofeedback to give occupational and physical therapists access to an affordable user friendly rehabilitation package.The LegTutor together with its sister devices (HandTutor, ArmTutor and 3DTutor) aim to optimize motor, sensory and cognitive performance to allow the patient to better perform everyday functional tasks and improve quality of life. The Tutors are being successfully used in leading U.S. and foreign hospitals and clinics and are suitable for home use through telerehabilitation.

Post Knee Replacement Therapy Includes the LegTutor

William C. Shiel Jr., MD, FACP, FACR associate clinical professor of medicine at University of California, Irvine, writing in MedicineNet.com composed important questions and answers concerning total knee replacement . Listed below are some of them.
What is a total knee replacement?
A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. The thigh bone (or femur) abuts the large bone of the lower leg (tibia) at the knee joint. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic “button” may also be added under the kneecap surface.
The posterior cruciate ligament is a tissue that normally stabilizes each side of the knee joint so that the lower leg cannot slide backward in relation to the thigh bone. In total knee replacement surgery, this ligament is either retained, sacrificed, or substituted by a polyethylene post. Each of these various designs of total knee replacement has its benefits and risks.

What happens in the post operative period?

It is important for patients to continue in an outpatient physical-therapy program along with home exercises for optimal outcome of total knee replacement surgery. Patients will be asked to continue exercising the muscles around the replaced joint to prevent scarring (contracture) and maintain muscle strength for the purposes of joint stability.
How does the patient continue to improve as an outpatient after discharge from the hospital?

Future activities are generally limited to those that do not risk injuring the replaced joint. Sports that involve running or contact are avoided, in favor of leisure sports, such as golf, and swimming. Swimming is the ideal form ofexercise, since the sport improves muscle strength and endurance without exerting any pressure or stress on the replaced joint.An important device that can assist in improving leg (and hip) movement in post knee replacement physical therapy is the LegTutor(pictured).
The LegTutor provides a safe and comfortable leg brace with position and speed sensors that precisely record three dimensional hip and 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 together with its sister devices (HandTutor, ArmTutor and 3DTutor) aim to optimize motor, sensory and cognitive performance to allow the patient to better perform everyday functional tasks and improve quality of life. The Tutors are being successfully used in leading U.S. and foreign hospitals and clinics and are suitable for home use through telerehabilitation.

Post Hip and Knee Surgery Therapy Aided by LegTutor

Mark McGraw writing in OUTPATIENT SURGERY magazine September 29, 2011 outlines
new recommendations from the American Academy of Orthopaedic Surgeons that may help physicians prevent a potentially serious complication following knee and hip replacement procedures.
The AAOS has released an updated clinical practice guideline that recommends how to reduce the likelihood of blood clots after hip or knee replacement surgery. The new guideline suggests the use of preventive treatments and advises against routinely screening patients after surgery using ultrasound imaging.
Physicians should instruct patients to stop taking anticoagulants such as aspirin and clopidogrel (Plavix) before hip or knee replacement because of the increased risk of blood loss during surgery with these drugs.
The guideline also suggests that patients discuss the timing of stopping any medication with their physician. Patients may also want to have the surgery performed under regional anesthesia, such as epidural or spinal, rather than general anesthesia. Although evidence suggests that these regional approaches do not affect the occurrence of deep vein thrombosis or pulmonary embolism, they do limit blood loss.
Regarding care after hip or knee replacement, the guideline recommends that patients shouldn’t have routine post-operative screening for thromboembolic disease with duplex ultrasonography. Screening with this test does not significantly reduce the rate of symptomatic DVT or PE, or the rate of fatal pulmonary embolism.
Patients should receive anticoagulant therapy and/or mechanical compression devices after a hip or knee replacement surgery. There is, however, insufficient evidence to recommend any particular preventive strategy, or the duration of these treatments. Patients should discuss the duration and type of preventive treatment with their physician. After hip or knee replacement, patients should get up and walk as soon as safely possible. Although there is sufficient evidence that early mobilization reduces DVT rates, early mobilization is low in cost, of minimal risk and consistent with current practice.
“Hip and knee arthroplasty is among the most successful of procedures in terms of restoring function and minimizing pain. However, one possible complication that orthopaedic surgeons are concerned about is venous thromboembolic disease,” says Joshua Jacobs, MD, orthopaedic surgeon at Rush University Medical Center in Chicago, Ill., and chairman of the work group that developed the guideline.
The LegTutor has shown great success in rehabilitating hips and knees post surgery. This innovative device, joined by its ”sisters” the ArmTutor, HandTutor and 3DTutor, is a brace attached to the affected leg and is connected by sensors to a computer with a dedicated intensive exercise program. Leading U.S. and foreign hospitals including clinics are now using the devices. Tele rehabilitation allows for adult and child patients to receive therapy sessions in their own home.

Tutor system an Integral Part of Post Surgery Rehabilitation

In an article by Seo5 Consulting it is reported that the arm, hands and wrists can be injured in a variety of ways through, sports, office work or an injury. After arm surgery patientswill need to rest and recover. During this recovery phase, when the arm is not in use, strength and muscle mass will be lost, in addition to the damage that was caused prior to the surgery.
Patients can begin to strengthen and rehabilitate their injury, with their doctors clearance, and are normally referred to a physiotherapist to start their physical therapy. Physical therapy in combination with a fitness program, and a healthy diet will help patients restore their arm so that they can get back to their day-to-day activities.
Physical therapy is a health care profession with a primary goal of restoring movement and flexibility, while improving the quality of life for patients that are recovering from an injury or surgery. A physical therapist will work with their patient one-on-one, helping them on physical and emotional levels, to overcome the challenges of their injury through physical movement and motivational counseling.
A clinic that is equipped with a facility for exercise allows the patient the convenience of meeting with their physical therapist in the same location where they were treated for their surgery. This helps patients to remain consistent with their treatment, to aid a quick and healthy recovery.
After physiotherapy or in combination with the treatment, the orthopaedic surgeon may recommend that the patient follows a fitness program at their on-site facility. This could be prescribed to restore or improve the patients cardiovascular capacity, or to supplement the physiotherapy treatment. Many physical therapists give their patients exercises to perform on their own, in between their sessions.
A good physical therapy program for post surgery patients should include the HandTutor, ArmTutor, LegTutor and 3DTutor sytem for maximum physical fitness training and an impairment based rehabilitation program.
The Tutor system includes devices that are FDA and CE certified and are being used in leading U.S. and foreign hospitals. They have had success in improving movement of the hand, wrist, elbow, knee, ankle, foot and other joints of the body following surgery and traumatic injuries. The devices have been effective for post stroke victims as well as for those suffering from Cerebral Palsy, spinal cord and brain injuries, Apraxia, MS, Parkinsons and other movement disabilities. Intensive active exercise can reduce the rate of deterioration and this is what the ”Tutor” devices provide.
The system is also used in physical therapy clinics as well as the patient’s home with tele rehabilitation. The ”Tutors” are suitable for adults and children.
Patients that are in the process of recovery should be considering the food that they put into their bodies, to assist with their recovery. After a workout, with the physiotherapist, or on their own patients should eat for replenishment. The body loses fluids and nutrients during a workout. A small meal consisting of protein, carbohydrates and vegetables will restore the bodys electrolyte supply and the fluids that have been lost. The patient should always drink enough water to stay hydrated and to keep the joints lubricated.
After undergoing surgery at an orthopaedic and sports medicine clinic, patients should stick to their physiotherapy and fitness training, and eat a well balanced diet before and after physical exercise, to ensure a healthy body that is preparing for the most complete recovery possible.

Tutor System and Tai Chi-A Great Combination

Ruth E Taylor-Piliae and Bruce M Coull of the College of Nursing, University of Arizona, USA examined the safety and feasibility of a 12-week Tai Chi intervention among stroke survivors.
Two-groups were formed in an outpatient rehabilitation facility. The subjects were stroke survivors ≥50 years of age and at ≥three months post-stroke.
The Tai Chi subjects attended group-based Yang Style classes three times/week for 12-weeks, while Usual Care subjects received weekly phone calls along with written materials/resources for participating in community-based physical activity.
Indicators of study safety and feasibility included recruitment rates, intervention adherence, falls or adverse events, study satisfaction, drop-outs, and adequacy of the outcomes measures.
The results of the study were that interested persons pre-screened by phone (n = 69) were on average 68 years old, (SD = 13) years old, 48% (n = 33) women, 94% (n = 65) were at least three months post-stroke. A total of 28 subjects aged 69 (SD = 11) years enrolled in this pilot study. Intervention adherence rates were very high (≥92%). There were no falls or other adverse events. The dose of Tai Chi exercise (≥150 minutes/week) was well tolerated. Overall study satisfaction was high (8.3 (SD = 1.9); 1 = not satisfied, 10 = most satisfied), while drop-outs (n = 3, 11%) were unrelated to study intervention. Score distributions for the outcome measures were approximately normal, sensitive to change, and seemed to favor the Tai Chi intervention.
The conclusions reached were that Tai Chi is a safe, community-based exercise program for stroke survivors. Our data suggest that recruitment and retention of an adequate sample is feasible, and that in a full-scale study 52 subjects/group are needed to detect statistically significant between group differences (alpha = 0.05, power = 0.80).
Exercise programs that include the Tutor system can enhance the recovery of victims of stroke, head, brain and spinal injuries, Parkinson’s disease, CP, MS, and other disabilities.
The HandTutor, ArmTutor, LegTutor and 3DTutor are devices that are FDA and CE certified and are being used in leading U.S. and foreign hospitals. They have had success in improving movement of the hand, wrist, elbow, knee, ankle, foot and other joints of the body following traumatic injuries. Intensive active exercise can reduce the rate of deterioration and this is what the ”Tutor” devices provide.
The system is also used in physical therapy clinics as well as the patient’s home with tele rehabilitation. The ”Tutors” are suitable for adults and children.

Tutor System Beneficial in Exercise Programs

Charlotte Winward MSc in an online publication on September 27, 2011 reports that fatigue is one of the most disabling non-motor symptoms for people with Parkinson’s disease. Exercise may modify fatigue. This study examines prescribed exercise effects on physical activity levels, well-being, and fatigue in Parkinson’s disease.
In this single-blinded trial, participants were randomly assigned to either a 12 week community exercise program or control group. Primary outcome measures were fatigue (Fatigue Severity Scale) and physical activity.
Thirty-nine people with Parkinson’s disease were included: 20 in exercise and 19 in control. Sixty-five percent of the study group were fatigued (n = 24, mean 4.02, SD 1.48). Increased fatigue was associated with lower mobility and activity (P < .05). Individuals participated in a mean of 15 (SD 10) exercise sessions with no significant change in fatigue, mobility, well-being, or physical activity after exercise (P ≥ .05).
The conclusion drawn was that participation in weekly exercise did not improve fatigue in people with Parkinson’s Disease.
The HandTutor, ArmTutor, LegTutor and 3DTutor have been used as an excellent exercise program for patients suffering from Parkinson’s disease or recovering from brain or spinal cord injuries.
The Tutor system consists of ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients 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 system consists of 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 FDA and CE certified.

LegTutor assists Spinal Cord Injury Victims

Jim Webber writing for LostLettermen.com reports that most people would have given up on the idea of walking again if it had been nearly two decades since they had done it.
But almost 20 years since he was paralyzed on an NFL football field, it appears as if the resolve of former Detroit Lions offensive lineman Mike Utley hardens each day in pursuit of his dream: Walking off the field at the Lions’ stadium, Ford Field.
That’s because on Nov. 17, 1991 — a date that is forever etched in Utley’s memory — a freak injury resulted in him breaking his neck and being carted off the field at the Pontiac Silverdome while he flashed a “thumbs up” sign to lets fans and teammates know he would be OK.
And so Utley, now 45, remains determined to walk off an NFL field one more time because, as he put it, “A man walks on the field of battle and he walks off the field of battle.”
That’s why today you will find Utley waking up each day at 5 a.m. about three hours east of Seattle in Wenatchee, Wash., and working out vigorously. He lifts four times a week and does physical therapy twice a week while running the Mike Utley Foundation with his wife, Dani, in hopes he will one day help find a cure for spinal cord injuries.
Because as much as Utley tries to will himself to walk again, even he admits, “I need science.”

It’s amazing that Utley has come this far after initially being unable to move his arms after the injury. Now he’s not only able to use his shoulders, arms and hands, Utley can function on his own, is regularly involved in action sports and even has partial movement in his legs.”I can walk with ankle braces, I can walk with crutches or a walker,” Utley said. “The problem is, it’s not really functional, as in to be independent, to be able to go to the grocery store. It’s still more feasible and — safety-wise — it’s more productive for me to be able to transfer into my chair and go to the mall, go shopping, get groceries, clean up around the house.”
It’s clear from talking to Utley that he’s not satisfied with any moral victories like these and will stop at nothing short of walking off Ford Field under his own power. He’s an engaging man who has a penchant for speaking in the third person, and his optimism and enthusiasm permeate his every word.
It’s impossible to set a timeline for when he will walk again since it will require a breakthrough in science, but that doesn’t stop Utley from being eternally optimistic.
“Mike Utley will walk off Ford Field, his game plan is today,” he said. “If it’s not today, it will be tomorrow.”
As such, Utley has turned his foundation into his legacy, raising money not only to further spinal cord injury research, but also to aid spinal cord injury rehabilitation and education.
The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity in spinal cord injuries. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the lower extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. 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. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease. Those sportsman like Mark Utley can use the Tutor system to bring more movement back to their injured joints.
The LegTutor™ allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.The LegTutor™ system, which includes the HandTuor, ArmTutor and 3DTutor is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.
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