Four Ways to Treat Apraxia

 

Generally speaking Apraxia is the loss of  ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements.

1. TREAT THE UNDERLYING DISORDER

When a brain tumor/lesion is the cause of apraxia, sometimes the apraxia can be diminished or cured   by treating the cause. Surgery, chemotherapy and radiation   are the standard courses of treatment for a brain tumor. Even after treatment, it’s common for some of the tumor to remain, but reducing it may help to treat symptoms of apraxia. Some rehabilitation therapy may still be needed to regain the ability to speak or perform everyday tasks.

2. RESTORE LOST MOVEMENTS WITH REHABILITATION

Occupational and physical therapists usually treat the patient where one or more body parts is affected . Physical therapists   teach the motor skills needed to perform  everyday tasks which is the purvue of occupational therapists.   Usually these two therapies complement each other but they can be used independently if the situation calls for it. For mild to moderate apraxia, these therapies usually are focused on restoring movements lost  resulting   a neurological event. This is usually accomplished with repetition of these movements and other drills.

3. COMPENSATE FOR LOST MOVEMENTS

The prognosis for severe apraxia is not as good, but therapy can  compensate for some of the lost movements in different ways. For example, a patient with severe apraxia that has limited ability to walk may be able to use a walker in rehabilitation therapy. Or a patient with apraxia of speech to the point of muteness can be taught to communicate with gestures or sign language. Experienced rehabilitation specialists can evaluate the patient to determine the best approach for therapy. Often compensation therapy is used if restorative therapy isn’t effective.

4. SPEECH AND LANGUAGE THERAPY FOR DEVELOPMENTAL APRAXIA OF SPEECH

Developmental apraxia of speech in children requires speech and language therapy for treatment. Unlike some cases of acquired apraxia of speech, developmental apraxia of speech does not resolve spontaneously. Speech therapy typically involves repetition of words and phrases, drills in front of a mirror and many other exercises. How the therapy is conducted is highly individualized. Parents are encouraged to continue exercises at home and provide a supportive environment. With adequate therapy, the prognosis for most children with developmental apraxia is good.

When children from the age of 5 and up as well as adults can benefit from intensive exercises for Apraxia-related limb disabilities the TUTOR system of physical therapy products is very useful. Specifically the HANDTUTOR, ARMTUTOR and LEGTUTOR provide

 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 by the occupational and physical therapist.This ensures that the patient stays motivated to do intensive repetitive manual therapy and exercise practice.

 The HANDTUTOR, LEGTUTOR, ARMTUTOR and 3DTUTOR are now  part of the rehabilitation program of leading U.S. and European hospitals and clinics. Home care patients can use the TUTORs through tele-rehabilitation. The TUTOR system is fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

 

Five Ways to Relieve Arthritis Pain

Arthritis has no known cure–just relief from pain. It’s called– exercise. Below are 5 exercises that are designed to bring joint relief, relieve stress and assist in weight loss. They can be fun too.

Doctors say that physical activity  is the best medicine  there is for arthritis pain relief, .

Patience White, M.D., chief public health officer of the Arthritis Foundation and professor of medicine and pediatrics at the George Washington University School of Medicine states that exercise can decrease pain, especially for people with osteoarthritis which is the most common type of arthritis.

 In the Cochrane Database of Systematic Reviews it was reported that exercise, such as walking, was  as effective  as drugs like Aleve or Advil in reducing knee pain.

By working out regularly it  may prevent sore joints and stop arthritis from getting worse.

Kevin Fontaine, Ph.D., assistant professor of medicine at the Center for Mind-Body Research at Johns Hopkins University School of Medicine in Baltimore states that  physically active people  have a higher quality of life and are less likely to become disabled or have days with lots of pain.

 Workouts also keep off the pounds. Obesity can increase the risk of arthritis and/or make its symptoms worse.

 Just 20 minutes three times a week or two 10 minute intervals is enough to make a difference according to Arthritis Today, the journal of the Atlanta-based Arthritis Foundation.

There are also new medications that can help relieve arthritis pain and swelling allowing patients to work out according to  Halsted Holman, M.D., professor emeritus of medicine and former director of the Stanford Multi-Purpose Arthritis Center at Stanford University’s School of Medicine.

Generally it is necessary to begin exercising only with a physician’s agreement.

A workout should be a challenging experience, but not painful enough to cause injury, Dr. Holman says.

 If you have sore joints or muscle pain that continues for even two hours after exercising or if the pain is worse the next day then the exercises were overdone. In that case the workout should be shortened or done more gently.

Here are 5 arthritis exercises that are sure to ease  arthritis symptoms:

1. Walking

 Walking is known to strengthen muscles, which in turn helps shift pressure away from the joints, and reduces pain.

 It also brings nourishing oxygen to the  joints by compressing and releasing cartilage in the knees.

 The Arthritis Foundation recommends walking 10 minutes at least 3-5 days a week to start.

As you progress, take longer walks and include short bursts of speed getting to a moderate pace until you are able to walk 3-4 miles an hour.

 People with serious hip or knee problems should first check with their doctor before beginning a walking program.

2. Water Exercise

How it helps: The University of Washington Department of Orthopedics and Sports Medicine recommends warm water – between 83˚ F and 90˚ F – to help relax  muscles and decrease pain.

Swimming and aerobics exercises in water are good for stiff, sore joints.

Water also supports the body as one moves. This reduces stress on the knees, hips  and spine, and offers resistance without any weights.

Water exercises are  ideal for people who need to relieve severe arthritis pain in knees and hips.

Arthritis Today quotes “Water provides 12 times the resistance of air, so one is  really strengthening and building muscle”.

When immersed in the water don’t pedal faster than 50-60 revolutions a minute. Add resistance  after a warm up period of  five minutes and don’t add more pedaling than you can handle.

3. Indoor Cycling

Matthew Goodemote, head physical therapist at Community Physical Therapy & Wellness in Gloversville, N.Y.  says that indoor cycling is one of the best ways to get a cardiovascular workout without stressing weight-bearing joints.

 Since there’s no need to lean the bike to turn a stationary bike is  a good option for people with balance issues – a common problem among some arthritis patients.

 When starting this arthritis exercise be sure that the seat height is at a position which allows the knee to be completely straight  when the pedal is at the lowest point, according to the University of Washington Department of Orthopedics and Sports Medicine.

One should not pedal faster than 50-60 revolutions per minute. A warm up period of five minutes should be allowed at first. Then patients should start 5 minute sessions 3 times a day. Then increase gradually to 7 and up to 20 minutes a day providing there is no pain.

 People with very painful knees should avoid indoor cycling, because it can aggravate the condition.

4. Yoga

 Steffany Haaz, MFA, a certified movement analyst, registered yoga teacher and research coordinator at Johns Hopkins Arthritis Center says that beginner yoga classes that have simple, gentle movements gradually build balance, strength  and flexibility  which are elements that can be  beneficial for people with arthritis.

Yoga  reduces inflammation, increases energy and, in general, allows for a more positive mental outlook, according to Psychosomatic Medicine, an Ohio State University study published in their journal.

To start, take a class at a  gym,  community center or yoga studio. You can find a certified teacher through the Yoga Alliance, the accrediting body for yoga instructors worldwide. It is important to tell the instructor before class about your  arthritis  so that they can  modify poses to accommodate your limited mobility.

For those that prefer doing Yoga at home,  there is a company called Gaiam that produces yoga videos and recently collaborated with the Mayo Clinic to produce a DVD entitled  “The Arthritis Wellness Solution” . It contains tips from specialists and a segment showing specific yoga for arthritis sufferers  and includes meditation exercises which are designed to enhance circulation and  relieve tension which helps relieve arthritis pain.

 Yoga should never hurt. If it does that means it’s overdone.

Straps, blankets and chairs can be used  to accommodate people with  limited range of motion, strength or balance.

5. Tai Chi

This traditional style of Chinese martial arts  goes back centuries and features slow, rhythmic movements to induce mental relaxation and enhance balance, flexibility and strength.

Tai chi is very valuable to arthritis patients because its movements are very slow and controlled. They put little force on the joints.

Some studies have shown that Tai Chi can improve life satisfaction, mental well-being  and perceptions of health, which oppose negative effects of  pain associated with arthritis.

The November 2009 issue of Arthritis Care & Research, a journal of the American College of Rheumatology has an article that describes Tai Chi as being beneficial for knee pain. Another research study by a Tufts University group found that Tai Chi was especially helpful for patients that were over 65 and had knee osteoarthritis.

According to another university’s Orthopedics and Sports Medicine department, Tai chi should preferably be done in the morning,  when there is  least pain and stiffness, when you’re not tired and when the arthritis medication is most effective.

Taking a warm shower is always a good idea before exercise if joints are stiff.

One of the most effective exercise programs for arthritis sufferers is by using the TUTOR system of physical therapy products. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR were originally designed to help patients that suffered a stroke, brain injury, Parkinson’s or other upper and lower limb disabilities. However much relief has been gained for arthritis patients as well  who would like a challenging and entertaining system of exercising arthritic joints. The TUTORs are ergonomically designed gloves and braces that contain sensors connected to sophisticated exercise games. The physical and occupational therapists monitor and record the progress made and design a customized exercise program for that patient.

Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE. They are also available in the home through the use of telerehabilitation and can be used by adults and children from the age of 5 and up.

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

Chocolate Eater Makes Medical History

A 52 year old woman, named Jan  Scheuermann, ate chocolate after a brain operation. So what? One might ask. However this simple act made history because Jan is paralyzed from the neck down

Originally diagnosed with a degenerative brain disorder 13 years prior  doctors implanted tiny electrodes in her brain which allowed her to operate a robotic  arm.

Jan’s ultimate wish was  to feed herself chocolate once the electrodes had been in place.

Doctors, led by Professor Andrew Schwartz of the University of Pittsburgh Medical Center, applauded her feat.

The arm is a  prosthetic controlled directly by the brain and  this achievement marked a major step for people who are unable to move their own arms.

“Our study has shown us that it is technically feasible to restore ability and gives patients hope for the future”, said Dr. Schwartz.

The two  microelectrodes were implanted into Jan’s left motor cortex. This is the part of the brain that initiates movement.

A scanning technique called ”functional magnetic resonance imaging” (fMRI) located the  part of the brain that lights up when the patient is asked to think about moving her paralyzed arms.

The electrodes were connected to the robotic hand through a computer which ran an  algorithm to translate the signals that imitates the way an unimpaired brain is able to control healthy limbs.

Decoding human motion has no limit now. It is quite complex when one works on parts like the hand for example, but  once the desired motion is tapped  how that motion will be effected has a wide range of possibilities according to the medical researchers.

For those brain injured patients that still have arm mobility the ARMTUTOR and HANDTUTOR offer an effective physical therapy solution.

The ARMTUTOR™ and HANDTUTOR systems have been developed to allow for functional rehabilitation of the upper extremity including the shoulder, elbow and wrist. The system consists of an ergonomic wearable glove and arm brace together with dedicated rehabilitation software. The ARMTUTOR™ and HANDTUTOR systems allow the physical and occupational therapist to report on and evaluate the patient’s functional rehabilitation progress. This allows the PT and OT to prescribe the correct customized and motivating intensive exercise practice to the manual rehabilitation therapy. Intensive repetition of movement is achieved through  challenging games set to the patient’s  ability. The 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. Telerehabilitation allows the recovering patient to continue his physical therapy at home. The system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

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

Multiple Sclerosis Symptom Guidelines

People who develop Multiple Sclerosis (MS) are usually between 20 and 40 and display at least two symptoms before being seen by the doctor.

Blurred or double vision

Weakness in one or more limbs

Cognitive difficulties

Sudden onset of paralysis

Slurred speech

Lack of coordination

 Early symptoms of MS include:

Tingling

Loss of balance

Numbness

Later, as the disease progresses, other symptoms may appear such as fatigue, muscle spasms, sensitivity to heat, sexual disturbances and changes in thinking or perception.

Fatigue is typically present in the afternoon and may include increased muscle weakness,  mental fatigue, or sleepiness.  Many patients with MS complain of  fatigue even after a good night’s sleep.

Heat sensitivity which can worsen symptoms  occurs in most people with MS.

Spasticity. Muscle spasms are a common  symptom of MS. Spasticity  affects the muscles of the legs and arms, and may interfere with being able to move those muscles freely.

Dizziness. A feeling of “off balance” or lightheadedness or that the surroundings are spinning is common; this is called vertigo. These symptoms are due to damage in the complex nerve pathways that coordinate vision and  are needed to maintain balance.

Impaired thinking  occurs in about half of the people with MS. This can manifest itself by slowed thinking, decreased concentration, or decreased memory.  10% of people with the disease have it so severe  that they cannot carry out  tasks of daily living.

Vision problems can include blurring or graying of vision or blindness in one eye.

Abnormal sensations. Many  MS patients experience  sensations such as numbness, “pins and needles,”  burning, itching,  stabbing, or tearing pains. Even though these symptoms are aggravating, they are not life-threatening and can be  treated.

Speech and swallowing problems in people with MS are caused by damaged nerves that normally would aid in performing these tasks.

Tremors are fairly common in people with MS and can be debilitating and difficult to treat.

Difficulty walking is among the most common symptoms of MS.  This  is related to muscle weakness and/or spasticity.   Balance problems or numbness in the  feet can also make walking difficult.

There are other rare symptoms which include breathing problems and seizures.

 The symptoms can be divided into three categories: primary, secondary, and tertiary.

Primary symptoms are a result of the  impairment of the transmission of electrical signals to muscles  and the organs of the body.  These symptoms include: tremors, weakness,  tingling, paralysis, loss of balance, numbness, vision impairment and bladder or bowel problems. These can be kept under control through the use of medication and rehabilitation.

Secondary symptoms are a result of primary symptoms. For example, paralysis  can lead to bedsores  and bladder or urinary incontinence  can cause frequent urinary tract infections. Although these symptoms can be treated,  the ideal goal is to  treat the primary symptoms.

Tertiary symptoms include psychological, social,  and vocational complications that are associated with the primary and secondary symptoms. Depression can be a common problem for those  with MS.

Deterioration of the protective sheath (known as Demyelination) that surrounds nerve fibers, can occur anywhere in the brain or spinal cord.  Demyelination in the nerves that communicate with the muscles causes problems with movement (called motor symptoms) and demyelination along the nerves that carry  messages to the brain causes disturbances in sensation.

Multiple sclerosis is a varied and unpredictable disease. For many people, it starts with a single symptom, followed by months or longer without any progression of symptoms. In others, the symptoms can become worse within weeks or months.

There are many symptoms, as stated above, but it is important to know that a given individual may only experience some of the symptoms and not others. With some the symptom may occur and then disappear. It is not wise to compare one MS patient with another.

When the symptoms reach a level where physical rehabilitation can be helpful the most effective solutions should be incorporated into the patient rehabilitation treatment program. Such solutions would include the TUTORs. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients in rehabilitation centers,, private clinics and the home supported by telerehabilitation. The TUTORs have been used to create an intensive exercise program for patients who have had MS or stroke, Parkinson’s disease, head or brain injuries, CP and other upper and lower limb disabilities.

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

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

Exercise For Cancer Patients

70% to 80% of cancer patients suffer from various kinds of fatigue.  The exact cause of cancer-related fatigue is uncertain; however, there are a few possible causes, which include the cancer treatment itself and the effects of the tumor. There are  comorbid medical conditions including anemia, hypothyroidism, cytokines, and sleep problems; psychological factors such as anxiety  and loss of functional status. A number of studies have  identified some benefits of physical activity on fatigue in cancer both during and after  treatment. A number of limitations in the original review show that an updated review is necessary.

The aim of this study  is to evaluate the effect of exercise on cancer-related fatigue both during and after cancer treatment.

 Aerobic exercise can help relieve fatigue related to breast and prostate cancer both during and after treatment, according to an updated review published on November 14, 2012 in the Cochrane Database of Systematic Reviews.

Fiona Cramp, PhD, from the Faculty of Health & Life Sciences, University of the West of England, and James Byron-Daniel, PhD, from the School of Psychology, University of West England, Bristol, United Kingdom state that the findings suggest that aerobic exercise should “be considered as one component of a management strategy for fatigue that may include  other interventions and education as well.”

Previously, patients with cancer were  encouraged to rest because of their  fatigue. However, now this approach is considered counterproductive because the patient’s inactivity can lead to muscle wasting as well as  a loss of cardiorespiratory fitness which can lead to increased fatigue.

Dr. Cramp and Dr. Byron-Daniel write that further research is necessary to determine the most effective parameters of exercise for fatigue management which should include  multi-modal exercise (a combination of resistance and aerobic), duration and frequency  of each exercise session, and the intensity of the exercise.

“It has yet to be determined whether the type of cancer treatment changes the  effects of exercise on cancer-related fatigue”, the doctors note.  Research is still needed to examine a broader range of cancer diagnoses, including patients that have an advanced form of the disease.

Most studies were from those with breast cancer although there were some with various cancer diagnoses. The exercises  occurred  during and after cancer treatment. The duration of the exercise intervention ranged from 3 weeks to 1 year and involved resistance training, aerobic activity  or flexibility exercises.

The exercise intervention varied widely, from home-based to supervised programs, and the intensity varied from self-administration to programs that involved heart monitoring  and oxygen uptake.

 Some sessions were conducted daily and some just 2 times a week; some sessions lasted 10 minutes and others lasted 120 minutes.

 Aerobic exercise like walking and cycling had a  significant benefit over no exercise.

The authors state that the  review should not be considered in isolation.  Nonpharmacologic interventions can also be considered  beneficial. Interventions that may be used together with an exercise program can include nutrition therapy, stress management  and sleep therapy.

Breast and prostate  are the two types of cancer where symptoms of fatigue can be reduced according to Dr. McNeely,  assistant professor in the Department of Physical Therapy at the University of Alberta and in the Department of Oncology and the Rehabilitation Medicine Department at the Cross Cancer Institute in Edmonton, Canada.

It is not clear yet if other forms of exercises such as weight training and yoga can provide the same benefits. More evaluation is needed, according to Dr. McNeely.

Even if formal exercising is not possible it is still imperative that cancer patients stay as active as possible. Staying active will help to prevent losses in muscular strength and overall fitness and will reduce fatigue.

Dr. McNeely states that more vigorous exercise after cancer treatments may be appropriate but should be administered by an exercise specialist.

Obesity as a Complication to Knee Arthroplasty

Hawaiian woman (Photo credit: Wikipedia)

 

 

In a  study by  Gino M.M.J. Kerkhoffs, MD, PhD, from the Department of Orthopedic Surgery, Orthotrauma Research Center Amsterdam, University of Amsterdam, the Netherlands and his colleagues, about obesity as a well known risk factor for total knee arthroplasty.  The rates of obesity and total knee arthroplasty have increased with the increasing prevalence of obesity. It is not clear whether obesity itself is a risk factor for poor outcomes following total knee arthroplasty. Differing results have been reported  for complications and revision rates among obese or nonobese patients who have undergone total knee arthroplasty.

This is a  study examining outcomes after total knee arthroplasty to determine if obesity  contributes to poorer short-term and long-term outcomes.

According to a meta-analysis published in the October 17, 2012 issue of the Journal of Bone and Joint Surgery obese patients are more than 2 times likely to incur deep infection, nearly twice as likely to incur infection after a total knee replacement, and somewhat more likely to require a surgical revision than those who are not obese.

The surgical outcomes for total knee arthroplasty among those with a body mass index (BMI) of 30 kg/m2 or more were surveyed together with outcomes for patients with BMIs lower than 30 kg/m2.

The authors found that obesity was a persistent risk factor for infection.

 According to Marc DeHart, MD, from Texas Orthopedic in Austin and a clinical assistant professor at Texas A&M Health Science Center in Bryan, as told to Medscape Medical News “The study is the highest level of science that we have in orthopedics. Dr. DeHart was not associated with the study and stated “It’s hard to do a blinded study, and that’s the only  study that would be better.”

Although specific studies that looked at knee replacement outcomes with obese and nonobese patients have shown mixed results, with some showing no difference between the two patient groups and others that  reported higher levels of complications, Dr. DeHart said the current research confirms what most orthopaedic surgeons have noticed in their practices.

 Orthopedic surgeons understand people who are heavier are harder to operate on and also have other issues related to their health. It takes longer to do cases, it’s harder to get them out of the hospital, and  they have more anxiety and more stress according to Dr. DeHart.

He stated that the infection rates could have been even higher if the authors compared patients with BMIs of 35 or 40 kg/m2 and up to patients of normal weight.

The study authors agree that there is a lack of definitive conclusions from earlier studies and  suggest that they were underpowered.

Even with a higher complication rate, total knee replacements allow for an important improvement for patients with a high BMI and it’s  still worth doing knee replacements in most of these patients because they have pretty good improvement according to Dr. DeHart.

For those people for whom it works well, they’re  very happy.

Patients recovering from knee surgery, obese or not, benefit from the latest physical therapy products such as the LEGTUTOR. The LEGTUTOR consists of a comfortable ergonomically designed leg brace that contains position and speed sensors record precise 3 dimensional knee movements. The LEGTUTOR has a range of motion limiter that limits the dynamic range of extension and flexion of the knee. Special rehabilitation games allow the patient to exercise the limb’s speed and accuracy of movement.

The LEGTUTOR  together with its sister devices (HANDTUTOR, ARMTUTOR and 3DTUTOR) are currently in use in leading U.S, and European rehabilitation hospitals and clinics. They are fully certified by the FDA and CE and are available for use by adults and children from the age of 5 and up. The TUTORs can also be used at home through telerehabilitation.

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

 

Post ACL Surgery Rehabilitation Study

Charles P. Vega, MD, FAAFP , Washington University School of Medicine authored a study of  anterior cruciate ligament (ACL) rehabilitation strategies after surgery. The study was posted on  October26, 2012.

The anterior  cruciate ligament (ACL) is  one of the four major ligaments of the human knee.

There are about 80,000 ACL  injuries in the United States each year, according to a review by Waters (J Orthop Sports Phys Ther. 2012). These injuries are quite common among basketball players, with female players more frequently injured than male players. Also, more than half of basketball players who undergo ACL reconstruction may suffer either a tear of the ACL graft or a tear of the ACL of the contralateral knee within 5 years.

Because of the widespread nature of ACL injuries and reconstructive surgery, understanding the best practice for rehabilitation of patients after ACL reconstruction is critical.

The cornerstone of postoperative ACL rehabilitation is Range-Of-Motion, strengthening, and functional exercises. Bracing following ACL reconstruction has been found to be neither necessary nor beneficial,  did not improve pain or knee laxity and just adds to the cost of the procedure.

It is crucial for ACL surgery patients  to begin physical therapy early and rigorously. Although it can be difficult at first, it’s worth it in terms of returning to sports as well as  other activities according to  Rick W. Wright, MD, also from the Department of Orthopedic Surgery, Washington University School of Medicine.

The following are some of the results of the study:

On the basis of limited research, immediate postoperative weight-bearing, range-of-motion exercises from 0° to 90° of flexion, and closed-chain strengthening exercises after ACL reconstruction appear safe.

Eccentric quadriceps strengthening and isokinetic hamstring strengthening at 3 weeks after ACL surgery may improve strength more rapidly.

Home rehabilitation regimens can be very effective even though  there are limited data to support this conclusion.

Vitamin C and E supplements do not appear effective in helping patients after ACL reconstruction.

Hyaluronic acid injections to the knee administered 8 weeks post surgery may improve ambulatory speed and muscle torque.

Single-leg cycling can improve cardiovascular fitness after ACL reconstruction.

For post operative limb surgery such as ACL repair the most effective physical therapy solution should be incorporated into the rehabilitation program.

The recently developed LEGTUTOR by MEDITOUCH is one such product. The LEGTUTOR consists of a safe comfortable leg brace with position and speed sensors that precisely record three dimensional hip and knee movements. The LEGTUTOR has a range motion limiter that can limit the dynamic range of knee extension and flexion. Rehabilitation games allow the patient to exercise Range Of Motion, speed and accuracy of movement. The LEGTUTOR facilitates evaluation and treatment of the lower extremity including isolated and combined hip and knee movements.

Currently in use in leading U.S. and European hospitals and clinics the LEGTUTOR together with its sister devices (HANDTUTOR, ARMTUTOR and 3DTUTOR) are fully certified by the FDA and CE and can be used at the patient’s home through telerehabilitation.

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

Telehealth Comes of Age

What do the following have in common?

Rural areas, medical insurance companies, 200,000 patients, cardiac patients, mental health patients, neurological telehealthdisease patients, suicide prevention and oncology follow-up care. An unlikely group of terms? Not if you consider that all of these derive a benefit or support from TELEHEALTH. In this age of high technology many medical procedures and benefits can be accomplished remotely and with as much expertise as with a face to face encounter with a professional.

Today, telehealth   is fast taking its place as a major aspect of healthcare and is understood more than ever before.

According to Jonathan Linkous, CEO of the American Telemedicine Association (ATA),  telemedicine is growing by leaps and bounds, and is due to double its current use in upcoming years.

More and more people and agencies of all kinds are joining the telehealth bandwagon.”

Telehealth used to be prevalent in rural areas mostly, where it is vital for care. However now, it is used in all parts of the country, Linkous said.

It has also attracted the interest of insurance payers. ”In the next few years,  major healthcare payers will be making interesting announcements” about telehealth, he said.

According to Linkous, tele monitoring is used by 200,000 patients nationwide. It is used to monitor one million cardiac patients a year alone, and provides 400,000 virtual visits  to mental health patients, via Skype.

The majority of patients being treated for neurological diseases are currently connected to a telesystem outside of a hospital. Nearly every major neurologic healthcare organization is using the system.

The Department of Veterans Affairs has recently begun to use telehealth to focus on mental healthcare. Beginning in July, the VA has used instant messaging in a suicide prevention program to help keep 6,000 vets online until assistance can arrive. The VA is also using telemedicine on oncology follow-up care.

When a physical therapy solution is needed and the patient lives too far from a rehabilitation facility or is back home after substantial recovery from a stroke or other limb disabling disease or surgery the TUTOR system is equipped with telerehabilitation to allow the patient to receive therapist monitored exercises.

The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are physical therapy products that consist of ergonomically designed gloves and braces with sensors connected to dedicated software. This software contains challenging games whereby the patient can use his own power to move a disabled limb or joint. The therapist then designs a specific exercise program for that patient based on his abilities.

The TUTOR system is currently in use in leading U.S. and European hospitals and clinics and is fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for further information.

 

 

Treating Pediatric Movement Disorders

A child’s brain has a remarkable ability for reorganization. In other words  even after a significant injury, uninjured parts of the brain can take over some or all of the function of the damaged parts.  Neurons do not generally re-grow and therefore “plasticity” or reorganization   is probably the major mechanism by which children improve or recover after a brain injury.  It is likely that plasticity plays an important role in maximizing the child’s abilities even in progressive or degenerative diseases.

It is likely that plasticity mechanisms are significantly enhanced by appropriate exercise, although there is not yet conclusive evidence about that. Therefore schooling, physical therapy and occupational therapy are important not only to improve strength and teach skills, but  to help the brain relearn and adapt to its injury as well. This may be particularly true with movement disorders, since a child can be able to learn alternative strategies for movement that utilize use of residual neurological and musculoskeletal function. At  a minimum, by maintaining joint mobility and preventing muscle contracture, occupational and physical  therapy preserve the ability for a child to  use these muscles and joints in the future.

Evidence from research in  humans and animals shows that the brain can adapt rapidly (even over a period of a few weeks) to changes in the use of  limbs. In regards to childhood movement disorders common physical and occupational therapy aims at intensive exercise practice to train the appropriate use of  limbs as soon as possible after the event. Thus intensive early and customized manual therapy will have long-term benefits and improve functional movement ability outcome.  In addition early intensive training will postpone or prevent future worsening of symptoms.

When deciding how to administer the most efficient method of therapy it is important to use the physical therapy solution that can be customized to the patients movement ability even if this movement ability is badly impaired after the event. The TUTOR physical therapy products have now been used successfully in leading U.S. and European rehabilitation hospitals and clinics to administer intensive exercises to both adults and children who have limb movement disorders in both the acute and chronic phase post event. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR consist of ergonomically designed gloves and braces with sensors connected to sophisticated and challenging software that allow the patient to practice isolated and/or interjoint coordination exercises. The system then provides the therapist with the patient’s motor, sensory and cognitive progress.  Subsequently a customized exercise program is formulated for that patient.

Fully certified by the FDA and CE the TUTORs are also available in the patient’s home through telerehabilitation.

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

Dupuytren’s Contracture (DC), A Hand Disorder– Its History and Treatment

Dupuytren’s contracture (DC) is a condition consisting of a shortening and thickening of the palm’s tissue which results in clawing of the fingers. Its cause is unknown, but  is thought to be hereditary. Other causal factors may include advancing age and  conditions, such as diabetes, alcoholism  and epilepsy. Treatment may include a range of therapies, surgery and exercises.

The hand palm  contains a  layer of tissue called the palmar fascia, which reaches across the palm to the fingers. DC is a thickening and shortening of this web of fascia that gradually can cause clawing of the fingers because they are pulled towards the palm. Any finger can be affected but the ring and little finger are usually affected.

DC tends to progress in an on and off method, and may take years to finally limit the functioning of the hand. The  cause of the disease is unknown, but it usually occurs among certain groups which include:

DC can sometimes run in families,  suggesting a genetic component. The type of treatment depends on the severity of the condition, but could include injections of corticosteroids into the hand and surgery.

Features of DC include:

A lump or nodule  on the palm, which usually appears close to the bottom of the ring or little finger.

There is what appears to be a thickened cord  along the palm to the fingers.

In time,  the fingers become clawed because they are pulled towards the palm.

The hand bows, the fingers are  pulled against the palm and the skin of the palm is dimpled and puckered..

There is rarely any associated pain.

Contributing factors to the  exact trigger are unknown. However, they may include:

Heredity – the condition tends to occur in families.

Ancestry –  Celtics or Scandinavians  are at  an increased risk.

Age – the condition occurs more  in middle to later years of life.

Gender – almost 10 times more men than women are affected.

Alcoholism – the contracture seems to be more severe in alcoholics.

Certain medical conditions – people who have diabetes and epilepsy have a higher incidence of DC.

Although in most cases, only the hands are affected other associated difficulties can include:

Garrod’s pads – the  joints of the finger on the same hand may enlarge and become thick.

Peyronie’s disease – there may be thickening and shortening of penis tissue .

Ledderhose disease – creates thickening and shortening  of deep connective tissue on the foot. As the disease progresses, this can cause  severe pain while walking.

The type of treatment depends on the severity of the condition. In its initial stages, treatment may include injections of corticosteroids into the fascia. These medications can reduce  localised tenderness and may  delay subsequent thickening of the tissue.

Other treatments include calcium channel blockers,  percutaneous needle fasciotomy and treatment with gamma-interferon.

If as in severe  cases, the person is unable to lay their hand palm-down on a flat surface, or their fingers have contracted into their palm so that the hand is no longer functional surgery may be indicated. DC can sometimes return after surgery, either at the same place or somewhere else on the palm.

The surgery options may include:

Cutting the fascia bands through small incisions in the palm

Removing the fascia and associated skin, and using a skin graft to seal the palm

Amputation of an affected finger, if the problem has returned so many times that corrective surgery is no longer a viable alternative.

Occupational therapy is necessary after surgery in order to speed recovery and reduce any risks of the contracture returning.

Specific techniques may include:

A splint worn during daytime.

A splint worn at night for several months in order to straighten the finger

Special hand exercises to encourage flexibility

Massage with moisturising hand cream.

When exercising the hand is indicated the use of the HANDTUTOR will afford excellent intensive exercises for the patient. The HANDTUTOR is a safe comfortable ergonomically designed glove containing position and speed sensors that precisely record finger and wrist motion. Rehabilitation games allow the patient to exercise range of motion, speed and accuracy of movement including opposition and pinch movement practice.

Currently in use in leading U.S. and European hospitals and clinics the HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) are fully certified by the FDA and CE. They are available for adults as well as children from the age of 5 and up and can be used at home through telerehabilitationDC.

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