Improving posture and gait in children with spastic–type cerebral palsy (STCP). A trunk-targeted intervention Strength and posture

Posture and gait is improved by Physical therapists that target trunk strengthening in rehabilitation programmes for children with Cerebral Palsy. Researchers from the Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University , Cape Town , South Africa writing in Developmental Neurorehabilitation, 04/09/2013 and working with spastic–type cerebral palsy (STCP) children use trunk-targeted intervention and show improvements in strength and posture and distance walked.

Reducing the risk of impairment of body structure and function in CP patients

Published in Clinical Rehabilitation, 03/06/2013 Rodby-Bousquet E and team from Department of Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden show that the Posture and Postural Ability Scale could reliably detect postural asymmetries in adults with cerebral palsy. The adults were cerebral palsy patients aged 19-22 years with levels I-V of the Gross Motor Function Classification System. Postural asymmetries are thought to lead to impairment of body structure and function such as muscle imbalance, gait asymmetry and possible chronic conditions therefore clinicians should include postural assessment as part of their routine evaluations in an effort to achieve postural symmetry and reduce the risk of chronic conditions associated with impairment of body structure and function in CP patients.

Comorbidity of ADHD and Motor Problems in Children–Some Solutions

Up to 50% of children with ADHD have motor problems which can have a severe impact on their daily lives. It seems that little attention is placed on this comorbidity issue and it goes untreated.

A study was conducted by interviews and questionnaire in The Netherlands with 235 children with ADHD and 108 controls showing that half of motor-affected children had received physiotherapy. Children that were treated had more severe motor problems but less frequently presented with comorbid anxiety and conduct disorder. Both groups (treated and untreated) were of the same general age, and rated similarly on ADHD testing scales and parental socio-economic status.

Apparently at the time of the survey undertreatment of motor problems in ADHD children occurs and behavioral factors play a role in referral and intervention.

Health workers should be aware of the impact of motor problems on the daily life of children with ADHD

 In clinical practice there seems to be less attention given to motor problems. Motor problems are usually not part of assessments for ADHD and are typically not included in intervention programs. A  child’s popularity and self-esteem is usually affected. Motor problems can cause difficulties in, for example, riding a bicycle, dressing, tying shoelaces or causing poor handwriting and sports abilities and can  further reduce children’s social participation and make them even more disadvantaged.

There are studies that have conclusively shown that physiotherapy of motor problems, especially child–centered, task-oriented approaches, can ameliorate motor disability and thus quality of life. Physical therapists  or occupational therapists can deliver interventions.  Parents and teachers can be instructed to manage motor problems as well, which may be helpful in case there are limited professional resources.

In the current study, the researchers examined if they could substantiate the clinical impression that motor problems don’t receive enough attention in the treatment of ADHD comorbid disorders. The main goal was to investigate in a well-diagnosed sample of children that had combined subtype ADHD, how many and which children were treated for motor problems. The investigation determined if treated and untreated children differed in age, gender, ADHD inattentive and hyperactive-impulsive symptoms scores, motor scores,  comorbidity with other conditions  such as: mood disorders, anxiety disorders,  conduct disorder, defiant disorder and socio-economic status of parents.This was done in order to predict actual treatment administration.

To detect  motor difficulties the Developmental Coordination Disorder Questionnaire  was completed by parents, and the Groningen Motor Observation scale was completed by teachers.

The parental socio-economic status was based on information concerning parents’ professions, gathered during the PACS interview. Professions were categorised into five levels, from manual labor to academic work.

A questionnaire concerning physical domains was designed for this study. This questionnaire was completed by parents and contained 36 questions about  motor milestones, sleep habits, development, infections, hospital admissions, medication and use of physiotherapy. The question that was evaluated in this study was : ‘Has your child ever been treated for motor problems by a physiotherapist?’

The study confirmed the impression that motor problems of children with ADHD are a neglected area of clinical attention. Roughly only half of the children with ADHD and motor problems in the study had received physiotherapy.

Apparently parents seek help earlier than teachers for children that are ADHD  This finding may point to a lack of communication on this subject between teacher and parents.

Physiotherapy or occupational therapy has been proven effective for treating motor problems.  Modern intervention methods are child-focused and help children  acquire important skills for daily activities, which can increase their quality of life.

When a child from the age of 5 and up develops motor problems due to ADHD there is a physical therapy solution that can be very helpful. Referred to as the TUTOR system it consists of a HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. Originally designed for patients that are recovering from a stroke, brain or spinal cord injury, CP, MS or many other upper or lower limb disabilities the TUTORs incorporate exclusive and challenging games into sensor-containing gloves and braces that allow the user to get intensive exercises. The ADHD child will actually enjoy using these devices at the same time that they are alleviating his motor problems.

Currently in use leading rehabilitation facilities around the world the TUTORs are fully certified by the FDA and CE.

For further information see WWW.MEDITOUCH.CO.IL

Disability, Depression and Rehabilitation

Disabilities make it harder to take part in normal daily activities. They may limit what you can do physically or mentally, or they can affect your senses. Disability doesn’t necessarily mean unable, and it isn’t a sickness. Most people with disabilities can – and do - learn, work, play,  and enjoy full healthy lives. Mobility aids and assistive devices can sometimes make all the difference., About one in every five people in the United States has some kind of a disability. Some people are born with a disability. Some get sick or have an accident that results in a disability. Some people develop disabilities as they age. Almost all of us will have a disability at some point.

 Disabilities can lead to depression. Depression is a serious medical illness that involves the brain. Being “down in the dumps” or “blue” for a few days is not what depression is about.   If you are one of the more than 20 million people in the United States who have depression, the feelings do not always go away. They persist and can interfere with your everyday life.

Symptoms can include:

Loss of interest or pleasure in activities you used to enjoy,

Sadness,

Difficulty sleeping or oversleeping,

Change in weight,

Feelings of worthlessness,

Energy loss,  and even

Thoughts of death or suicide

Depression is a disorder of the brain. There are a variety of causes, including environmental, genetic, psychological, and biochemical factors. Depression can start between the ages of 15 and 30, and is much more common in women. Postpartum depression after the birth of a baby can also cause major depression. Some people get an affective disorder in the winter or around the holidays especially if they are separated from family and friends. Depression is one part of bipolar disorder.

There are effective treatments for depression, including antidepressants, talk therapy and physical rehabilitation for a disability. When the disability is a result of a stroke, brain or spinal cord injury, Parkinson’s disease, MS, CP or any other upper or lower limb surgery or disease efforts should be made to employ the most effective physical, solution available. This may encourage the best way to return to the pre event emotional status. One of the most efficient physical therapy products available today is the TUTOR system by MEDITOUCH. The MEDITOUCH rehabilitation system consists of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. These are ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients in rehabilitation centers, private clinics and the home and can be supported by telerehabilitation. It is designed for those that 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. The dedicated software allows the therapist to fully customize the exercises to the patient’s ability. Most important is that the TUTOR system optimizes the patient’s motor, sensory and cognitive performance allowing him to better perform everyday functions again and thereby to reduce depression.

Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE.

See WWW.MEDITOUCH.CO.IL for further information.

Complimentary Medicine and Physical Disabilities

A U.S. national survey   researching the connection between the use of complimentary medicine and those that have a physical disability produced some interesting results.

Matthew J. Carlson, Ph.D. and Gloria Krahn of Portland State University and Oregon Health & Science University

conducted the survey, the purpose of which was to estimate the prevalence of complementary and alternative medicine (CAM) as used by the practitioner, assess the reasons for its use, and determine the symptoms for which CAM practitioners were consulted. This was conducted  in a national US sample of insured adults with physical disabilities.

The methods used were data  from a longitudinal survey  on a national sample of some 830 adults covered by health insurance who had one of the four disabling conditions: cerebral palsy, multiple sclerosis, arthritis and spinal cord injury. Cross sectional analysis of the data produced estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted.

The results showed that CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. The use of CAM was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%). It was used by former devotees (62%) compared to non-users (8%).  Spinal cord injury reported the lowest use (14%). The most common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). The common reasons for using CAM practitioners included a lifestyle choice (67%) and also because they are perceived to be more effective than conventional medicine (44%).

The conclusions of the  survey suggest that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning.

Effective treatment of physical disability can also be achieved by obtaining and using the correct physical therapy product. Leading the pack is the TUTOR system. Consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR these recent innovations have been created to treat physical limb disabilities as a result of a stroke, brain or spinal cord injury, Parkinson’s disease, MS, CP and other upper or lower limb disabilities.

The TUTOR system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. Consisting of ergonomicaly designed gloves and braces the TUTORs optimize the patient’s motor, sensory and cognitive performance and allows him to better perform daily functional tasks and thereby improve his quality of life.

The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are available at home through telerehabilitation. Fully certified by the FDA and CE the TUTORs can be used by adults as well as children from the age of 5 and up.

See WWW.MEDITOUCH.CO.IL for further information.

How Children and Seniors Should Exercise

Out of 1,440 minutes in every full day at least 30 of them should be scheduled for physical activity.

Exercise is a critical part of staying healthy and people who are active usually live longer and feel better. Exercise can help  maintain a healthy weight, delay or prevent diabetes plus some cancers and heart  problems.

Adults need 30 minutes of moderate physical activity at least five days each week. This can include bicycling, walking briskly, dancing, mowing the lawn, swimming for recreation.  Stretching and weight training can also be used to strengthen the body and improve  fitness level. It’s important to find the right exercise. If it is fun there is more motivation.Walking with a friend, joining a class or a group bike ride is an example. However if no exercise has been done for a while, then a sensible approach to exercise should be used by starting slowly.

CHILDREN also need exercise. Most children should have at least an hour of physical activity daily.

Regular exercise helps children:

Feel better about themselves

Feel less stressed

Keep a healthy weight

Feel more ready to learn in school

Build and keep healthy joints, bones, muscles

Sleep better at night

Today kids spend more time watching TV, and  spend less time playing and running .  TV, video games and computer time should be limited. Parents should be active themselves thereby setting a good example for their children. It can also be more fun to exercise together. Kids can get exercise by biking to school, bowling, dancing and of course walking to places.

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SENIORS know that there is no fountain of youth. However the secret to feeling better and living longer is staying active. Finding the right program that works can pay big dividends to one’s health. Regular exercise can also prevent or delay diabetes and heart trouble. Exercise can also reduce pain from arthritis, anxiety and depression. All of these can keep seniors independent longer.

Senior exercise programs should include:

Aerobics to improve the health of the heart and circulatory system

Strengthening exercises which reduce age-related muscle loss and build muscle tissue

Endurance-”staying power”-activities – like walking, swimming, or riding a bike

Stretching exercises to keep the body flexible and limber

Balance exercises which can reduce the chances of  falling

There are physical therapy products that can be used by children and adults that can strengthen muscles so that there is less likelihood of a debilitating injury if an accident should occur. The ARMTUTOR and LEGTUTOR are such devices. They are braces that are strategically
placed and contain sensors connected to dedicated software that allows the user to get intensive exercise. Physical and Occupational therapists monitor these movements and design a specific program for each user.

Originally created for patients of stroke, brain/spinal cord injuries, Parkinson’s disease, CP, MS and other upper and lower limb disabilities the TUTOR system (which also includes the HANDTUTOR and 3DTUTOR) is used extensively in leading U.S. and European hospitals and rehabilitation clinics. They are fully certified by the FDA and CE.

See WWW.MEDITOUCH.CO.IL for further information

C.I.M.T. Versus Intensive Occupational Therapy

A conclusion was drawn from a recent study by Wallen etal from Sydney, Australia that modified constrained induced therapy (CIT) isn’t any more effective than intensive occupational therapy. The study was conducted on activities of daily living and also upper limb outcomes for children with hemiplegic cerebral palsy.

 Dr. Stephanie DeLuca  of the University of Alabama at Birmingham and her colleagues who have long been involved in CIMT research and raise some  questions about the Wallen study. They state:

We raise many  issues about the Wallen  study and also present directly comparative data from another trial of CIMT that we recently completed. The purpose of the comparative data is to assist readers to better interpret the magnitude of changes reported among children in both Wallen  treatment groups – for an objective outcome and a subjective one.

The concern is  that when clinical trials are conducted in a way that doesn’t clearly specify the intervention treatment or to document its fidelity of implementation, readers will be at a loss as to how to use the findings. Strict clinical trials have  agreed upon standards as to what constitutes adequate, objective outcome data. Based on the Wallen article, the  study did not meet criteria of what a rigorous clinical trial with appropriate primary outcomes should be.

The professional field is eager to solve critical questions about whether Constraint-Induced Movement Therapy (CIMT) works, and also for whom it works best, and which dosage or constraint yields the best results. The Wallen  study is described as if it answers  these questions. In fact, we judge the form of administration  and the dosage (below 1.5 hr/day) and form of constraint (a glove worn less than 1.5 hr per day) of the so-called “modified” Constraint-Induced Therapy to be an insufficient way of knowing if it in fact was really  CIT.

We feel that the field needs to develop very clear and agreed upon definitions for various therapy approaches, with  definitions and measures of the delivery of the components of this specified form of therapy. If not, we fear that CIMT – which till now has been  one of the most promising evidence-based therapies that is available for children who have unilateral cerebral palsy  –  may end up as earlier “popular” therapies that were not well defined (like Neurodevelopmental Therapy – NDT) and that it becomes a  disrespected therapy since no one can describe exactly what it is. In Dr.DeLuca’s view, the use of a short-term type of constraint with only a little more than a one hour therapy session each week cannot qualify as CIMT!

Children need evidence-based treatments. The field needs a trustworthy and solid  database to decide on  treatment recommendations and the therapist’s training  who deliver treatments. Wallen’s study  failed to clarify or even advance the role of CIMT per se. It did, however,  show that low dosages of CIMT don’t  produce large and statistically significant improvements in function even though some parents liked the intervention and were satisfied with the progress their children made.

When it becomes necessary to restrain one limb so that the weaker one can be involved in intensive therapy the TUTOR system is a preferred physical therapy solution.

The TUTOR system involves a number of components in particular the use of repetitive task-oriented training. This involves the person practicing a series of short tasks with the weaker arm for several hours a day over a two to three week period under supervision by a trained therapist. Whilst using the weaker arm the unaffected side is restrained, for example by wearing a mitt or glove to continually remind the person to use the weaker arm.

The person is encouraged to use the weaker arm outside of the treatment program for functional tasks at home whilst wearing the glove or mitt and is provided with a series of home assignments to complete. Research has proven that such intensive and repetitive use of the weaker arm over this short period leads to increased use of the weaker arm as well as improved quality of movement .

The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are physical therapy products that are currently being used by physical and occupational therapists to provide intensive therapy to children and adults affected by CP and many other limb disabling diseases and surgeries. The TUTORs are comfortable and ergonomically designed gloves and braces that are strategically placed on affected parts of the body. They are fit with sensors that are connected to exclusive software  allowing the patient to exercise his limb. Physical therapists monitor and record the patient’s progress and then design a customized program for that patient. Even when the patient has recovered enough to return home from a hospitalization his exercise sessions can continue to be monitored by the therapist through the use of telerehabilitation. Currently in use by leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE.

See WWW.MEDITOUCH.CO.IL for further information.

Ski Accident Statistics and Their Physical Therapy Treatment

Skiing is one of the world’s favorite sports and as such there are a fair amount of injuries to skiers. An  analysis of injury statistics compiled over 12 seasons, encompassing 2.55 million skier-days, at a  ski resort in Wyoming was used for a ski accident survey. Ticket sales per year was the method of calculating the population surveyed.   9749 skiing injuries were indexed by  region and severity according to diagnosis on the initial evaluation. The rates of injury were then analyzed as a function of time.

During the 12 seasons the injury rate remained constant at 3.7 injuries per 1000 skier-days.

During the study period the rate of lower extremity to upper extremity injury decreased from 4:1 to 2:1  .

The ankle injury rate also decreased with time.

7% of all injuries were Ulnar collateral ligament sprains.

30% of all injuries were knee sprains.

Anterior cruciate ligament tears increased as a function of time  and accounted for 16% of all skiing injuries during the same study period.

The most common injury was the medial collateral ligament sprain at 18% of all skiing injuries.

In addition there were also forty-seven snowboard injuries recorded.

 

All of the above injuries can be treated by physical therapy products known as the TUTOR system once the patient has been stabilized and is ready for rehabilitation. The TUTORs provide intensive exercise for all upper and lower limb injuries or surgeries. They are also effective for patients who have Parkinson’s disease, stroke, CP, MS, head and spinal cord injuries and other debilitating medical issues.

The TUTOR system consists of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. These products include  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 fully certified by the FDA and CE and is currently in use by leading U.S. and European hospitals and clinics. The suystem is available for children from the age of 5 and up and in the home through telerehabilitation.

Stroke Victims and Physical Therapy Gloves

It was reported on Oct. 23, 2012 that a mechanical glove has been devised to aid stroke victims by a Victoria  University, New Zealand student.

Abigail Arulandu has joined  a field that already has physical therapy products such as the HANDTUTOR that have proven success records that achieve the same thing and have been assisting stroke patients for several years.

Since most stroke victims have clenched hands as a result  of the stroke the purpose of therapy is to get them to expand and reuse the hand. Ms. Arulandu’s device has sensors that measure exerted force. The information gleaned is transmitted to physical therapists for analysis. The HANDTUTOR system uses exclusively designed games such as: Snowball, Car race, Bubbles, Asteroid attack and others to challenge the patient in an enjoyable way.

These exercises are aimed at bringing the patient to a state where they will be able to function as before the stroke.

Arulandu is attempting to emulate known physical therapy solutions for post stroke rehabilitation such as the HANDTUTOR and should be commended for her efforts.

The HANDTUTOR is one of several similar products already on the market such as the ARMTUTOR, LEGTUTOR and 3DTUTOR that are available and currently being used in leading U.S. and European hospitals and clinics. The ARMTUTOR is the device of choice for injuries and diseases affecting arm, elbow and shoulder problems. The LEGTUTOR assists patients who have had knee or hip replacement surgery. The 3DTUTOR is a wireless motion feedback device that can be positioned on discrete joints of the head, trunk, upper or lower extremities. This allows for evaluation and treatment of the joint of choice. The 3DTUTOR can be used alone or in combination with the ARMTUTOR or LEGTUTOR to exercise additional interjoint coordination movements.

The TUTOR system has also been used to rehabilitate victims of traumatic brain or spinal cord injury, Parkinson’s, CP, MS, Brachial Plexus Injuries and more.

All of the TUTORs can be used at home through the use of telerehabilitation and are fully certified by the FDA and CE. Prototypes of new and similar products are fun to create but why duplicate what is effective already?

More information about the TUTORs is available at WWW.MEDITOUCH.CO.IL

Traumatic Brain Injury and Youth Crime

A British report just published  makes some surprising and  alarming claims. Apparently, 60% of young people in the British justice system custody say they have experienced a traumatic brain injury. The report cites the fact that brain injury is more prevalent in the under 25 age group.This does not mean that brain injury turns those youths into criminals.

The report,  was written by Professor Huw Williams and commissioned by the Barrow Cadbury Trust for the Transition to Adulthood (T2A) Alliance. There is a prevalent belief in UK and US legislative authorities that once a person becomes 18 years of age he or she are mature individuals and therefore are responsible for their actions. This is at best unhelpful and at worst a tragedy of the criminal justice system. It can actually prolong the criminal behavior of an individual.

There is a basic misunderstanding of age boundaries. Age limits and restrictions rarely correspond to scientific evidence. A 16-year-old isn’t any more resistant to the damaging effects of smoking than a 14-year-old. As soon as someone reaches a legally determined age, they don’t automatically mature overnight. There is no internal  switch that gets flipped.

 ”Underage pregnancy” is somewhat of an oxymoron – if a female is physiologically capable of becoming pregnant, then she is old enough to reproduce as far as nature is concerned. But society rightly recognizes that just because someone is biologically capable of doing something, they are not necessarily mentally capable of doing it without causing damage to themselves or others. Ensuring an individual is mature enough to understand and handle the consequences of potentially damaging actions is why age restrictions exist.

But this concept of “maturity” is where problems arise.  The criminal justice system works under the assumption that, once an individual is 18, they are mature enough to be considered a typical adult.The argument made is that this is not the case, and that young adults should be recognized as a separate group by the criminal justice system, and their cognitive development maturity and socioeconomic factors should be considered fully when processing them, up to and including the court sentencing the individual.

 Scientific evidence  and a literature review by Birmingham University  supports this view. Studies into post-adolescent brain development reveal that  brains continue to develop well into our 20s, and these developments are concerned with more complex abilities like: executive functioning and inhibition. The latter  overrule our need for immediate reward, moderate our impulsive actions and regulate our emotions. That is what the majority of people would consider signs of maturity.

There is  another factor that has a serious impact on  cognitive development and behavior of young adults and that is brain injury and trauma.

Head injury is  very serious . A concussion is serious, even if it does not cause lasting damage. Any injury to the head that causes even a short period of unconsciousness should be taken seriously, as it could result in a  long-term injury. Because of the complexity of the brain and uncertain nature of brain injury, the eventual consequences of traumatic brain injury can vary, potentially leading to  disorders such as schizophrenia. Many “criminals” are imprisoned who suffer from schizophrenia. Should they be in prison or under treatment elsewhere?

In younger people brain injury is potentially more damaging, as it can potentially disrupt cognitive development.  These disruptions could lead to an increased tendency for criminal behaviour.

Those without a TBI [traumatic brain injury] are more likely to grow out of an immature and antisocial behavior by the time they get to the mid-twenties but those with TBI are likely to continue to grapple with these issues throughout young adulthood and beyond.

There can be no generalization, however, that all youths who suffer from TBI will graduate into a criminal life. Most do not. But in young adults, brain injury increases the likelihood of eventual criminal behavior.

However since there is a tendency for a relationship between criminal behavior and TBI this should be considered when making decisions about sentencing and rehabilitation. Today young people aren’t screened for brain injury and thus it is  rare that there would be necessary rehabilitation. As a result, the main contact that many young people with TBI have with those that provide services is via the criminal justice system, which  obviously can’t deal with and treat brain trauma.

It is strongly suggested, though, somewhat impractical at this time, that young offenders should be screened for TBI and treated which would then cut the rates of a reoffense and save the taxpayer costs in the criminal justice system.

Interestingly, work is already under way on some tools for determining the mental state and maturity of the offenders, such as targeted questionnaires. But ironically, this would be predicated  on the fact that offenders would be  honest with those responsible for prosecuting them. This would require a degree of maturity and control. The point made above is that they may lack the trait of honesty.

We should be aware how damaging it can be to demand certain types of behavior from teenagers (and then punishing them based on this) without considering the physiological and cognitive changes they are undergoing.

No one is suggesting that young offenders get away with their crimes but it is necessary to take into account the aspects of developmental maturity and brain injury which can affect their behavior and maybe reduce the likelihood of future crime and punishment.

When Brain injury occurs and there is paresis in a particular limb the most effective physical therapy solutions should be found when the patient is sufficiently recovered.

The newly developed HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) have become a key system in neuromuscular rehabilitation for patients recovering from brain and spinal injuries, Parkinson’s disease, MS, CP and other limb movement limitations. These innovative physical therapy products implement an impairment based program with augmented motion feedback that encourages motor learning through intensive active exercises and movement practice. The TUTORs consist of wearable gloves and braces that detect limb movement showing the patient how much active or assisted active movement they are actually doing. The rehabilitation software uses special  games to set a new target for this movement in terms of the patient’s 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 TUTOR system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice.

 The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are now part of the rehabilitation program in leading U.S. German, Italian, French, UK and other country’s hospitals and clinics. The TUTORs are available for adults and children from the age of 5 and up and are fully certified by the FDA and CE. They can also be used in the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.