LegTutor Enhances Range of Motion for Knee Replacement Patients

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Pazit Levinger et al conducted a study published in  Springer Link in October 2011.

The purpose of the study was to determine why knee pain and disability still persists following knee replacement surgery (TKR) which will place patients at increased risk of falls. This study looked at the falls risk and the occurrence of falls of people with knee osteoarthritis (OA) before and at 12 months following knee replacement surgery.

The method used in the study was:

Thirty-five patients with knee OA were tested using Physiological Profile Assessment both prior to undergoing knee replacement surgery and also at 12 months following surgery. The Physiological Profile Assessment  is an outcome measure that looks at vision, lower limb proprioception, knee extension strength, reaction time and postural sway. Other outcome measures included Physical activity, number of falls, fear of falling, pain, disability and health-related quality of life were also assessed.

The results  found no significant differences between no’ of falls pre- and post-surgery with 48.5% compared to 40% reporting at least one fall in the 12 months before and following the surgery. Improvement in knee strength/ reaction time/ fear of a fall were seen following surgery. There was no improvement in lower limb proprioception. Self-reported pain, function and stiffness did  significantly improve, but health-related quality of life (HRQOL) deteriorated following the surgery.

The group concluded that persistence of impaired lower limb proprioception may have contributed to the number of falls experienced following knee replacement surgery. In addition, although knee replacement surgery(TKR) improves function and alleviates pain, patients post TKR may need to engage in proprioception rehabilitation following the surgery to reduce the risk of falling.

The LegTutor has shown remarkable success in post knee replacement surgery. The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. Together with the 3DTutor the LegTutor can be used to increase the patients proprioception performance with dedicated games being developed in the rehabilitation software for this outcome. The Tutor system rehabilitation concept, which includes the HandTutor, ArmTutor and 3DTutor, is based on performing controlled exercise rehabilitation practice at a patient customized level including balance and proprioception training. This is achieved with real time accurate feedback on the patient’s performance.  The exercises are designed in the form of challenging rehabilitation games that are suitable for a wide variety of neurological and orthopedic injury and disease. The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice. Exercise practice is the most important manual therapy tool in the armory of physical and occupational therapists to ensure optimal rehabilitation.

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 is used by many leading rehabilitation centers worldwide for both neurological and orthopedic patients including adults and children. the Tutor system holds FDA and CE certification.

http://www.handtutor.com

Rehabilitation Facilities Using HandTutor ArmTutor, LegTutor, 3DTutor System Amongst the Best

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BOSTON, Oct. 18, 2011 /PRNewswire via COMTEX/ –  Gabrielle Giffords – The U.S. House of Representatives member has made a miraculous recovery after a gunshot head wound. You will never face a similar fate, however you may have other medical conditions -like  stroke, brain and spinal cord injury, neurological disorders (like Parkinson’s disease and multiple sclerosis), complex orthopedic issues, and amputation that will require intensive occupational and physical rehabilitation therapy. Will you receive the same quality of care as Gabrielle Giffords?

Here is what you will need to know so as to choose the best rehab facility.

Firstly freedom of choice

You will have a case manager who knows about your diagnosis, insurance coverage, and therefor can make recommendations for a discharge plan so that you can reach your functional rehabilitation goals and objectives. However, you the patient have a say about where you go for physiotherapy and OT.

Your options include:

A skilled nursing facility that can offer less intensive OT and PT rehabilitation therapy usually indicated for management of non-complex medical issues.

Long term acute hospitals – that can manage multiple system failure however has less focus on rehabilitation.

Inpatient rehabilitation facility – offering intensive rehabilitation services together with the management of complex medical issues. Here the physical and occupational rehabilitation is

best for short-term rehabilitation being ideal for those patients who have suffered a significant medical event, yet still well enough to benefit from intensive therapy.

Here’s what to ask when you are making the decision.

1. Is this the right rehabilitation facility to help me reach my goals? Consider if the facility has the experience in treating your orthopedic or neurological injury or disease. Does it have a  specialty program for your condition or a specialty program for children.

2. Is the physical rehabilitation an intensive programs giving at least 3  hours of therapy a day for at least five days a week.

3.  What technology does the facility use e.g motor learning intensive exercise motion feedback devices including the HandTutor, LegTutor, ArmTutor and 3DTutor,   functional electrical stimulation and robotics that show a proven success.

5. How is the facility rated among its peers? Is it accredited by the Joint Commission, use of Functional Independence Measure (FIM) scores.

6. Check if the facility can improve functional outcomes in physical rehabilitation with the best and latest equipment to treat injured limbs and joints. If the Tutor system is used the center may be one of the best to choose from.

The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy for interactive rehabilitation exercise. 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. This training is tailored and customized by the occupational and physical therapist to ensure that the patient stays motivated to do intensive repetitive manual therapy and exercise practice.   The HandTutor, LegTutor, ArmTutor and 3DTutor is now  part of the rehabilitation program of leading U.S. and foreign hospitals with the Tutors being used in clinics and at home cdare. Home care patients can be supported by the occupational and physical therapist offering tele-rehabilitation.

Cognitive Rehabilitation and the Tutor System Work Together

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John M. Grohol, Psy.D. reviewed the following information on October 13, 2011 for PSYCH CENTRAL
According to a government report, solid evidence is still lacking to show that that specific goal-oriented treatments are effective for traumatic brain injury, or TBI, however results are promising.

Statistics show that an estimated 1.7 million people in the United States sustain a traumatic brain injury or TBI and between 2000 to 2010, the number of military  personnel with TBI nearly tripled from 11,000 to > 30,700.

Traumatic brain injury is caused from a bump or blow to the head  or from external forces that result in the brain moving within the head examples include whiplash or exposure to blasts. The results caused include  cognitive, physical, and/or psychosocial problems.

One of the treatments for TBI is cognitive rehabilitation therapy (CRT). CRT is a goal oriented approach that helps patients increase their ability to process and interpret information. CRT involves a variety of treatments provided by health professionals including occupational and physical therapists. When the TBI causes joint movement impairment the Tutor system consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor has become invaluable.

Because TBI is considered the “signature wound” of modern conflict the U.S. Department of Defense has asked the Institute of Medicine (IOM) which is the health division of the National Academy of Sciences, to conduct research to determine the effectiveness of cognitive rehabilitation therapy for TBI treatment.

According to said Dr. Ira Shoulson – the head of the IOM committee that studied the problem and a neurologist at Georgetown University. The USA’s experience in Afghanistan and Iraq show that traumatic brain injury results in long-term challenges in physical as well as emotional rehabilitation and then reintegration to everyday life. Effective health care infrastructure and evidence-based treatment and rehabilitation policies needs to be implemented in order that we cope with TBI patients impairments.

The goal of cognitive rehabilitation therapy (CRT) is to help an individual who suffers from the physical and mental impairments caused by brain injury to improve his or her ability to move through daily life and recover or compensate for damaged cognitive or physical functions. A restorative approach will helps the patient reestablish cognitive function, while a compensatory approaches will help the individual adapt to an ongoing impairment.

When the disability is specifically physical the HandTutor, ArmTutor, LegTutor and 3DTutor have played an important role in interactive rehabilitation exercises.

The Tutor system including the HandTutor, ArmTutor, LegTutor and 3DTutor  have become a key system in neuromuscular rehabilitation and physical therapy improving functional outcomes for upper and lower limb disabilities due to TBI. 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 and physical movement ability. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of tele rehabilitation (TR).

Tutors Complement New Design for Physiotherapy

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News@Northeastern Home News Archives on October 14, 2011 featured an article about Prof. Constantinos Mavroidis and doctoral candidate Richard Ranky from Northeastern University who are developing new sensors for customizable devices designed to help doctors measure progress of physical therapy (physiotherapy) patients. Progress is gained using the HandTutor, ArmTutor, LegTutor and 3DTutor “Tutor system” which is improving functional outcomes in physical rehabilitation for patients suffering from MS, CP, Brain or Spinal cord injury, stroke, Parkinson’s disease and many kind of limb surgeries.

“Our work will bring the important field of physical rehabilitation further into the information technology world of tomorrow,” Constantinos Mavroidis said. Mavrodis is the principal investigator and a professor in Northeastern’s Department of Mechanical and Industrial Engineering.

Using a National Science Foundation grant, Mavroidis and doctoral candidate Richard Ranky plan to design tiny sensors that will be embedded into medical devices that are customized to an individual’s need. Examples of these devices include a handle or computer hardware for medical monitoring and therapy of a person’s hand. Then using a separate grant from the Center for Integration of Medicine and Innovative Technology (CIMIT) the technology developed will be used to design customized orthosis brace with these embedded sensor. The orthosis will be worn around the Achilles tendon and stabilize the ankle and foot. This is envisaged as doctors and physical and occupational therapists can measure the strength of a stroke patient’s grip or the distribution of pressure around their lower extremities when walking. This information will be used to determine the patient’s rehabilitation progress during  exercises and help predict when a device needs replacing based on everyday wear and tear.

 Similarly the Tutors allow for the customization of the treatment sessions. The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical and occupational therapy. These innovative devices implement an impairment based program with augmented feedback and this encourages motor learning through intensive repetitive active exercises. Intensive and repetitive exercise practice is the key to physiotherapists and occupaational therapists use of manual therapy and exercise practice. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance and for interactive rehabilitation exercises. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability.

The data would be collected electronically and wirelessly, so that doctors could monitor patients in person, or even receive the data transmitted from a patient in their home.

“Now that you can actually put a sensor inside a device and customize it for the user, this opens up a lot of new possibilities for personalized rehabilitation devices,” Ranky said.

The Tutors  are fully certified by the FDA and CE and are available for children as well as adults.

Tutors Effective in Stroke Rehabilitation – “It takes a lot of practice to make the brain better.”

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During a lecture to the  American Neurological Association Dr. Steven Crame is the University of California, Irvine (UCI), professor of neurology describes two therapeutic windows.   The first familiar sound to neurologists namely the clicking of the clock as they hurry to get tissue plasminogen activator on board in ischemic stroke patients. The second clock is measured in days or weeks a so called “golden” period during which combined restorative therapies and rehabilitation must be initiated to achieve maximum rehabilitation effects.

Talking about intensive active exercise practice Dr Cramer said: “It takes a lot of practice to make the brain better.”

Dr. Cramer describes  the concept of ”If you sprinkle your best restorative pixie dust on the brain, you’re not going to get the same effect as if you pair it with some kind of behavioral shaping. By this he means that Nature provide the first rapid response , the inflammation and pouring in of a wealth of growth events that look very much like a developing brain.This excitable brain is bringing in the building blocks for repair and regrowth of the cells, dendrites, and synapses etc.

These building blocks are possible therapeutic targets as this spontaneous repair can be amplified and enhanced.

However Dr. Cramer predicted that far more will happen if active physical rehabilitation is added to the mix.

“When the brain is fertile to undergo repair, whatever substance you give has maximum effect if it is paired with the right kind of experience,” Dr. Cramer said.

Stroke disability is one of many events or diseases that the Tutor system can be effective in restoring  joint and limb movement.  The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical and occupational therapy following brain injury including TB, cerebral palsy and Stroke. 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 intensive  training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and during home care treatments that can be done together with telerehabilitation.

How the TUTORS Help TBI Victims

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An article by SUSAN K. LIVIO for North Jersey.com on October 12, 2011 tells how nearly one in four injured service members returning from Iraq and Afghanistan have suffered a traumatic brain injury (tbi). This may force them to relearn and rehabilitate the most basic of functional skills including walking, talking and other everyday functional tasks.

Ron Sharp, 61 is a Vietnam veteran who is the first participant in a therapy program for New Jersey vets with traumatic brain injuries TBI. The program takes place at Bancroft NeuroHealth.

 The U.S. Department of Veterans Affairs has set up the $23.5 million Assisted Living-Traumatic Brain Injury pilot program and Bancroft NeuroHealth who have twenty 20 years of experience in dealing with such injuries such as TBI have won the contract in New Jersey from

Bancroft is one of the 21 nationally accredited agencies that won this three-year contract from the VA in June.

Cynthia Boyer, senior clinical director for Bancroft’s brain-injury program said that “Brain injury is … a lifelong condition.”

Physical and occupational therapy has to aim to improve a patients ability to perform functional living tasks so that they can be as independent as possible and this can be life long.

TBI accounts for 22% of all casualties and 59 percent of blast-related injuries in Afghanistan and Iraq with according to the U.S. Department of Defense, 161,025 service members having been diagnosed with a traumatic brain injury from 2000 through to 2009.

When TBI occurs and recovery is progressing the Tutor system (HandTutor, ArmTutor, LegTutor, 3DTutor) has shown much success in rehabilitation of joint movement. 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 sensory and motor  movement ability. In addition the physical and occupational therapist can objectively and quantitatively report to their colleagues and the patient on the treatment progress. In this way the HandTutor, ArmTutor, LegTutor, 3DTutor rehabilitation system optimizes the patient’s motor, sensory and cognitive performance and allows the patient to better perform everyday functional tasks and improve their quality of life. PT’s and OT’s use the FDA and CE certifiedcan  HandTutor, ArmTutor, LegTutor, 3DTutor rehabilitation system in major US and foreign rehabilitation clinics. Research has shown the efficacy of the Tutor system. See http://www.ncbi.nlm.nih.gov/pubmed/20740477

http://www.handtutor.com

Injury Prone Jordan Wynn Needs the ArmTutor

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LYA WODRASKA writing in The Salt Lake Tribune on October 11, 2011 reports that any hope remaining that quarterback Jordan Wynn will return this year ended Monday when the Utah Utes announced Wynn, who injured his left shoulder in the Utes’ thirty one to fourteen loss to Washington, must have shoulder surgery to repair the damage.

This will be the second surgery in less than a year for the junior, who had surgery in December on his right shoulder.

Wynn finishes this year 66-for-116 for 727 yards and six touchdowns with two interceptions. We saw that Wynn struggled throwing long due to the lingering effects from the December surgery and he now faces another long recovery following the repair to his nonthrowing arm.

Jordan will have to do intensive rehabilitation to come back as he is eligible for a redshirt season.

The ArmTutor can assist Mr. Wynn in regaining full use of his shoulder.

The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ 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. So early in recovery from shoulder surgery the occupational and physical therapist will work on improving range of motion and accuracy and speed of movements as well as muscle strength. The exercises are designed in the form of challenging games that are suitable for a wide variety of neurological and orthopedic injury and disease.

The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice.

The ArmTutor™ allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. 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.

The ArmTutor™system with its sister devices (HandTutor, LegTutor and 3DTutor) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

Comparing EMG Biofeedback and Tutor system movement feedback in Stroke

LIVESTRONG.COM features this article By Tamasin Wedgwood on Oct 5, 2011. In this article the American Stroke Association likens biofeedback to looking in a mirror to check that one is moving in the correct way. Electrodes measure bodily functions – heart rate, muscle movements or blood pressure – and the information is fed back to the patient. Biofeedback is mainly used in stress-related conditions, demonstrating to patients how relaxation improves symptoms. Its effectiveness after a stroke is disputed and still experimental.  However, there is growing interest in using biofeedback in stroke rehabilitation therapy.

Biofeedback takes three forms. Thermal biofeedback measures skin temperature. Neurofeedback measures brain activity and electromyography (EMG) measures muscle activity. Measurements captured by the electrodes are displayed on a monitor. A therapist explains this data to the patient. Initially by trial and error, the patient alters his behavior and the resultant readings are displayed on a screen. These changing readings provide visible evidence of how a patient’s reactions are influencing his symptoms or improving his bodily functions. In time patients learn to control their symptoms without needing the monitor.

During Stroke treatments EMG measurements of muscle activity that are not enough to effectuate movement are captured by the electrodes and displayed on a monitor. A therapist explains this data to the patient. The patient is asked to try his best to move his affected limb and is shown which technique results in the most muscle activity. EMG feedback can be used in physiotherapy and occupational therapy to help patients reeducate their limbs in movement by showing them how to control their muscle activity in order to teach them how to grip and release objects in a stroke-impaired hand.

As reported in a 2009 review in the Biofeedback Matters newsletter: Physiotherapy alone may improve grip but teaching brain injury including stroke patients to relax and release objects was harder. This is because the reflexes that control muscle activity in Stroke patients’ brains and muscles is damaged and overactive this causes continued muscle tension or spasticity when a patient desires to release an object. According to Dr. Richard Harvey of Chicago’s Rehabilitation Institute EMG Biofeedback can help to teach patients improved motor control but it cannot help patients rehabilitate a functional tasks.

The research summary shows the following examples of the effectiveness of biofeedback improving functional outcomes in stroke patients: A 1989 study from the Stroke Research Unit, Nottingham UK showed that stroke patients receiving EMG biofeedback regained more arm function than control group patients with patients with more extreme movement impairment showing the most benefit. A 1994 study from the stroke rehabilitation center in Rome showed similar benefits in biofeedback improving lower extremity leg strength. Unfortunately, many of the studies demonstrating benefits for stroke patients have been criticized for their small sample size and imprecise terminology. Dr. Robert Teasell at St. Joseph’s Health Care, London, Ontario rehabilitation hospital reviewed studies between the 1960s and 2003 he concluded that biofeedback did appear more effective than conventional therapies but larger studies are still needed. The American Stroke Association in 2006, confirmed and  updated this information by saying that up until 2006 these studies have not been done. The Tutor system established in 2004 with the aim of developing novel occupational and physical rehabilitation equipment based on the proven concepts of active exercise and biofeedback. The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation for stroke victims and 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 HandTutor ArmTutor, LegTutor, 3DTutor consist of wearable glove and braces that detect limb movement showing the patient how much active or assisted active movement theyare actually doing. The rehabilitation software uses special rehabilitation games to set a new target for this movement in terms of the patients ability to move their 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 is given movement feedback that allows the patient to understand which effort is more successful in allowing them to move their affected limb again. In this  way the Tutor system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice. The HandTutor ArmTutor, LegTutor, 3DTutor is now part of the rehabilitation program of leading U.S. German, Italian, French and UK and other foreign hospitals. http://www.handtutor.com

Tutor System Important Tool in Post TBI Therapy

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•  Zak Koeske writing in the Fairlawn Patch on October 9, 2011 reported about TBI survivor Jane Concato who discusses her own experience dealing with brain injury.
  About seven years ago Jane Concato rose out of bedearly in the morning in her Westwood home and headed downstairs however she slipped and her fall changed her life forever.
  Concato’s husband, Joe, heard the fall and immediately arose to see what had happened. He found found his wife unconscious, squeezed up against the front door. Jane’s fall fractured her skull and bruised  both her right and left temporal lobes leaving her in a coma at Hackensack Hospital for 3 weeks. Thus began Jane and her families life dalin with the effects of brain injury. Jane’s family were told by doctors to prepare for Jane not being able to learn to walk and talk again and just be prepared.
  Concata came out of a coma and underwent physcial and occupational rehabilitation therapy at Kessler rehabilitation centre in New jersey.
   Concato like many people didn’t know much about TBI traumatic brain injury pre fall. .
  The Brain Injury Association of New Jersey said that 12,000 – 15,000 of the 1.4 million Americans who suffer traumatic brain injuries annually are from New Jersey. BIANJ also estimates that  175,000 New Jersey residents live with the effects of TBI.
  During recovery for TBI patients are heavily involved in physiotherapy. One of the newest methods to enable them to improve functional outcomes in their rehabilitation is through the use of the Tutor system.
  The Tutor system, consisting of the HandTutor, ArmTutor, LegTutor and 3DTutor, has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. The system consists of ergonomic wearable devices including a glove and arm and leg brace. These devices use dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive massed controlled exercise practice which is the basic principle behing physical and occupational therapy manual exercise practice. The Tutor system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Additional features of the Tutor system include quantitative evaluation, objective follow up and tele-rehabilitation.
  The new medical devices are available for children as well as adults and through the use of telerehabilitation and are FDA and CE certified.