Biofeedback as a Therapy for Stroke Victims

Biofeedback, a system created in the 1950′s, shows muscle movement on a screen and can thereby instruct the therapist to assist the patient on further movements. It is used for hemiparesis, swallowing problems, urinary incontinence and even to improve cognitive impairments. It is not commonly used in physical therapy settings. However the HANDTUTORand its sister devices (ARMTUTOR, LEGTUTOR and 3DTUTOR) use a form of biofeedback in its system. The intensive exercises that the patient does with the Tutor are managed by fun games on dedicated and customized software created specifically for the TUTOR. The HANDTUTOR improves fine motor, sensory and cognitive impairments through these exercises.The HANDTUTOR also includes quantitative evaluations that provide a thorough documentation of patient performance that are evaluated by physical and occupational therapists. The HANDTUTOR consists of a unique ergonomic glove that detects finger and wrist motion. It comes in different sizes, is adaptable for children and adults and can be used at home through telerehabilitation. The Tutor system is certified buy the FDA and CE. See WWW.HANDTUTOR.COM for further information.

”Foot Drop” and its Rehabilitation

Also known as ”Drop Foot“, treatment for this disorder depends on the underlying cause. If the cause is successfully treated, foot drop may improve or even disappear.
By definition, “Foot Drop” is the dropping of the front of the foot which may be due to weakness, damage to the peroneal nerve or paralysis of the muscles in the rear portion of the lower leg. It usually is a symptom of a greater problem. It is the inability or difficulty in moving the ankle and toes in an upward position (dorsiflexion). It can occur on one or both feet. Foot drop can be caused by nerve damage alone. However, it is also caused by muscle or spinal nerve trauma, abnormal anatomy, toxins or disease.
The diseases that can cause foot drop include stroke, ALS ( Lou Gehrig’s Disease), muscular dystrophy, Charcot Marie Tooth disease, and MS. Treatment for foot drop may include: a) braces or splints that fit into the shoe and can help hold the foot in a normal position. b) Physical Therapy. Exercises that strengthen the leg muscles and help maintain the range of motion in the knee and ankle may improve gait problems. c) Stretching exercises can be very helpful to prevent the development of stiffness in the heel. Nerve stimulation of the nerve that lifts the foot improves foot drop. d) Surgery. Sometimes nerve surgery may be helpful. The surgery can fuse ankle or foot bones or transfer a functioning tendon to a different position.
If physical therapy is indicated and the patient is ready for the therapy stage then the LEGTUTOR may be effective.
The LEGTUTOR™ system has been developed to allow for functional rehabilitation of the lower extremity including the foot, knee and hip. (It is used for knee rehabiliation following total knee replacement and knee arthroscopy). The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The rehabilitation software allows the physiotherapist to set challenging game difficulties to the patient’s movement ability. In this way the patient undergoes controlled exercise rehabilitation practice exactly at their own movement ability. In addition the LEGTUTOR™ system gives the patient constant instructions on how to perform the exercise practice and biofeedback on how well they are performing the exercise. The quantitative biomechanical data from the evaluations in the software is used by the physical therapist to report to the patient and the multidisciplinary team on the patient’s rehabilitation progress.
Thus the LEGTUTOR™ and its sister devices (HANDTUTOR, ARMTUTOR, 3DTUTOR) allow for both upper extremity – shoulder, elbow, wrist, hand therapy and lower extremity – foot, hip, knee, ankle physical therapy using the same rehabilitation concept., The LEGTUTOR™ allows for isolated and a combination of foot, knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patient’s 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 is used by leading rehabilitation centers in the U.S. and European rehabilitation centers and clinics and has full FDA and CE certification. For further details see WWW.HANDTUTOR.COM

Prevention Hints for Stroke and Brain Injury

Although there is no guarantee that stroke or brain injury won’t ever occur there are several preventative tips that can be taken.
Brain injury prevention tips:
1) Wear helmets on bikes and during tackle sports
2) Wear seat belts in cars and trucks for adults and children
3) Avoid violent confrontations
4) Don’t drink and drive
5) Remove tripping hazards in homes such as throw rugs
6) Install non slip mats and grab bars in tubs and showers
7) Use handrails on stairs
8) Improve lighting where necessary
9) Exercise for lower body strength and balance
10) Install window guards even on low floors if you have small children
11) Install soft flooring in playgrounds
Stroke prevention tips:
1) Quit smoking
2) Manage high blood pressure
3) Control Diabetes
4) Eat healthy foods
5) Exercise regularly
6) Get regular medical exams
7) Avoid being overweight
8) Avoid stress
9) Control high blood cholesterol, alcohol and illicit drugs
10) Be aware of stroke symptoms: facial, arm, leg weakness; speech problems
However when one of these incidents occur and the patient is now on his way to recovery the TUTOR system can be very helpful for returning normal movement ability to any affected limbs or joints. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are gloves or braces that are attached to the appropriate part of the body. The associated exclusive software allows the patient to undergo intensive exercises in the form of challenging games which are monitored by physical and occupational therapists who then adjust the exercises to the patient’s ability.
The newly developed devices are already in use in leading U.S. and European rehabilitation hospitals and clinics. They are adaptable to be used in the home through telerehabilitation for patients that live too great a distance from a clinic or who have improved to the point where hospitalization is no longer needed. The TUTOR system is FDA and CE certified and can be used by adults and children.
See WWW.HANDTUTOR.COM for more information.

The Influence of Augmented Feedback After Stroke

In her Ph.d. thesis from University of Twente in Enschede, The Netherlands, Dr. Molier discusses the influence of augmented feedback on learning upper extremity tasks after stroke. The thesis is topical due to the increasing use of augmented feedback in physical and occupational therapy of the hemiparetic arm after stroke. Also it mentions the introduction of motion feedback and robotic systems including the HANDTUTOR, ARMTUTOR and LEGTUTOR. Based on literature reviews and her own work Dr. Molier discusses how augmented feedback has an added value to the rehabilitation and physical therapy of stroke survivors. It is that postion feedback during a functional task will show the errors that they are making and stimulate motor learning and how the patient corrects these errors. The TUTOR system - HANDTUTOR and ARMTUTOR gives the patient information on the position of more than one joint that they are exercising during the training task. This ensures that the patient is given feedback on the correct position of the arm during a functional task including reaching and pointing. This increases the benefit of the physiotherapy exercise training.
The evidence exists. TUTOR systems are relatively inexpensive so why not give the rehabilitation clinics in the US and National Health Service in the UK a budget to make the treatment options available. Allow the patient to use their disability allowances to purchase this technology and benefit from remote support, intensive physical rehabilitation and exercise practice which are shown to improve functional movement ability and rehabilitation outcome?
See WWW.HANDTUTOR.COM for more information.

When is Constraint Induced Movement Therapy (CIMT) Beneficial?

Not everyone that suffered a stroke or other paralysis of a limb can benefit from CIMT. However, if a comprehensive evaluation performed by qualified physical therapists to determine appropriateness of strengths and weaknesses show that it can help then this relatively new method can speed the improved use of the affected limb.(CIMT is a system whereby the unaffected limb is restrained so that all exercising is concentrated on the affected limb).
There must be some shoulder, elbow or finger movement in order for the system to increase motion and strength. No memory loss, lack of eyesight or severe pain should be prevalent in order for CIMT to be effective. Once applied this therapy can increase nerve activity to the brain. New areas of the brain can be put into use with sustained and repetitive practice. Side benefits can include improvements in core strength, balance and functional mobility.
The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are recent innovations in the area of intensive and challenging exercises used by stroke victims to improve the functional ability of an affected limb.
The TUTOR system has become a key system in neuromuscular rehabilitation and physical therapy for interactive rehabilitation exercises. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance by the occupational and physical therapist to ensure that the patient stays motivated.
The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are now part of the rehabilitation program of leading U.S. and foreign hospitals with the TUTORS being used in clinics and in the patient’s home through the use of tele-rehabilitation. See WWW.HANDTUTOR.COM for more information.

New Brain Tracking Shows Promise For TBI Patients

Till now MRIs of the brain discovered swelling and bleeding in the brain after a head injury but not much else. The injury was difficult to diagnose and they pretty much ”worked in the dark” when it came to predict outcomes and plans for rehabilitation and recovery. Now with new research that maps the brain (nerve) fibers–white matter–in living color doctors can determine where there are breaks in the wiring similar to seeing broken bones. The new MRI based computer programs can predict if a patient will wake up from his coma and in what condition. That way they can start rehabilitation in hopes of healing the patient. Basically the high definition fiber tracking predicts what will happen.
When it is determined that meaningful rehabilitation can take place and the patient is sufficiently recovered the TUTOR system can be put into use to try to reactivate affected limbs and joints. The TUTOR system which consists of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are a recent innovation created to challenge the TBI patient with intensive exercises through the use of dedicated software in the form of games that must be mastered. The patient accomplishes the various tasks using his own strengths while under the constant supervision of physical and occupational therapists. The therapists then customize an exercise program with augmented feedback.
The TUTOR system has been in use for some time now in leading U.S. and European hospitals and clinics for the rehabilitation of patients who have had a brain or spinal cord injury, Parkinson’s disease, CP, MS, stroke, upper and lower limb surgeries and other disabilities.
The TUTOR system is certified by the FDA and CE and can also be used through telerehabilitation in the patient’s home. See WWW.HANDTUTOR.COM for more information.

Telerehabilitation Therapy As Used by the Tutor System

Written in the Journal of Head Trauma Rehabilitation for a Defense and Veterans Head Injury Program Deborah L.Warden, MD etal reported on recent results of a controlled randomized trial comparing home versus inpatient cognitive rehabilitation for patients with moderate to severe head injury. It showed no overall difference in outcomes between the two groups. All patients in the home program received medical treatment as needed, a multidisciplinary in-hospital evaluation, and TBI counseling before entering the eight-week home program, which then included guidance on home activities.
When a patient as improved to the point that he doesn’t need inpatient care or if there is a homebound patient or if the patient lives at too great a distance from a physical rehabilitation facilty then telerehabilitation comes into play.
This is one of the features that the TUTOR system has. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR can be used at a distance from the patient’s personal physical or occupational therapist following inpatient treatment for traumatic brain or spinal cord injuries as well as for stroke, Parkinson’s disease, Cerebral Palsy, Radial and Ulnar nerve or Brachial Plexus injuries or any upper or lower limb surgeries where physical therapy is needed to improve the normal mobility of the affected limb(s).
The TUTOR system provides detailed exercise performance instructions and precise feedback on the patient’s efforts. Controlled exercise of multijoints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.
See WWW.HANDTUTOR.COM for more information.