Assisted active exercise practice and the HandTutor and ArmTutor

Occupational an physical therapists are using the MediTouch system in combination with active assistance. People with arm weakness can exercise their arms without assistance, but if their arms and hand movement ability is severely impaired, such exercise is difficult and compliance with exercise programs is low. Using the HandTutor and the ArmTutor the occupational therapist and the physical therapist can give the patient “assistance-as needed” to perform the required customized arm or finger a wrist exercise task. This clinical technique is known as active assisted exercise. During active assistance practice the patient actively contributes to the movement, this active exercise contribution is an essential feature of motor sensory and cognitive recovery and allows motor learning and plasticity. This means that the the HandTutor and ArmTutor can be used by patients with very little Active Range of Motion (AROM) as well as by patients with little ROM deficit.

Active assistance therefore allows OT and PT to use the MediTouch and provide their patients with severe deficits in AROM a customized exercise that gives immediate movement feedback and the enjoyment and motivation of video game based rehabilitation.

The MediTouch benefits patients with movement dysfunction or impaired functional activity caused by neurological disorders, including traumatic brain injury (tbi), stroke, cerebral palsy, spinal cord injury, and multiple sclerosis.

OT and PT therapeutic goals

The MediTouch system is a state of the art targeted rehabilitation system that hones in on specific therapeutic goals. Through the enjoyment and motivation of video game based rehabilitation which gives immediate feedback to the patient, the HandTutor, ArmTutor, LegTutor and 3DTutor address the challenge of impaired movement ability. The system is used in the clinic and at home and offers motivating customized exercise practice with OT and PT support.

The system benefits patients with movement dysfunction or impaired functional activity caused by neurological disorders, including traumatic brain injury (tbi), stroke, cerebral palsy, spinal cord injury, and multiple sclerosis. In addition the system is used for physical therapy after shoulder, elbow, hip and knee surgery.

Computer-based cognitive rehabilitation (CBCR) after stroke

Computer-based cognitive rehabilitation (CBCR) effective on improving cognitive function after stroke. This conclusion was reached by occupational therapists from Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. The group publish their results in NeuroRehabilitation, 04/16/2013.

The MediTouch HandTutor and ArmTutor work on improving motor sensory and cognitive movement ability through. The system is used in the clinic and at home and offers motivating customized exercise practice with OT and PT support.

Comparing the HandTutor to the Wii

The Wii is an example of a activity promoting video game (APVG). Practice with the Wii will increase recorded pulmonary ventilation (VE), oxygen consumption (VO2) and HR in normal uninjured subjects. Published in European Journal of Physical and Rehabilitation Medicine, 04/12/2013, Gaffurini P et al show that while practicing with the Wii Spinal cord injury (SCI) patients also saw an increase in energy expenditure (EE). The Physical and occupational therapists from the Laboratory of Neuromuscular Rehabilitation (LaRiN), University of Brescia, Italy conclude that APVG practice in subjects with SCI can be used to counteract deconditioning due to inactivity.

In contrast to exercise activity promoting video games, the HandTutor works with dedicated rehabilitation software that motivates the patient to do controlled finger exercise practice and improve their motor sensory and cognitive movement ability. This allows SCI patients to better do functional tasks. The MediTouch system  is a targeted rehabilitation systems that hones in on specific therapeutic goals. Through the enjoyment and motivation of game-based rehabilitation supported by the OT and PT the system addresses the challenge of impaired movement ability.

 

Motivation and participation in exercise practice improves rehabilitation outcome

Writing in Archives of Physical Medicine and Rehabilitation, 03/19/2013 Dr. Bolliger from Balgrist University Hospital Forchstrasse 340, 8008 Zurich discusses the importance of active participation of patients during robotic-assisted rehabilitation. The group looked at spinal cord injury patients (SCI).

The HandTutor, ArmTutor and LegTutor use augmented motion feedback so that the patients are encouraged to do repetitive customized active and assisted active exercises with instant feedback on their performance.

Web-based telemedicine provides specialty care at home for Parkinson Disease (PD)

Published in JAMA Neurol. 2013 Mar Dr. Ray Dorsey, Associate Professor of Neurology, Director of the Movement Disorders Center, Johns Hopkins University concludes that web-based videoconferencing and telemedicine for the provision of specialty care at home is feasible, effective and provides value to patients, and may offer similar clinical benefit to that of in-person care in  Parkinson Disease (PD). This indicates that telemedicine is feasible for other movement Disorders and neurodegenerative Diseases.

The HandTutor, ArmTutor and LegTutor is used at home by Parkinsons disease patients and is supported by telerehabilitation.

Upper limb Paresis after Stroke

Writing in Journal of the American Medical Directors Association, 03/05/2013 Dr. Timmermans from Department of Rehabilitation Medicine, Maastricht University, Maastricht, The Netherlands quotes that More than 50% of patients with upper limb paresis after stroke face long-term impaired arm function and ensuing disability in daily life.

The HandTutor and the ArmTutor is used by outpatients and home patients to improve functional upper limb movement ability.

How does movement imagery and observation improve outcomes of intensive and repetitive exercise practice

Writing in Neuropsychologia (Feb 2013) Dr. Maslovat School of Kinesiology, University of British Columbia, BC, Canada and team discuss hte mechanism by which imagery and observation of movements – covert movements involve similar motor preparation and neural pathways to overt movements or exercise practice. MediTouch is currently studying implications on how the timing of these covert movements improve movement ability outcomes of physical and occupational therapy using the HandTutor, ArmTutor and LegTutor.

Improving post stroke upper limb dysfunction will improve quality of life

Published in Disability & Rehabilitation Dr. Morris and colleagues from the University of Dundee, Dundee, UK look at the health related quality of life (HRQOL) of stroke patients 6 months after the event. His paper discusses how upper limb/ extremity impairment affects patient perceived (HRQOL). The group conclude that management strategies including physiotherapy and occupational therapy that facilitate UL recovery and improve activities of daily living will benefit patient quality of life.

The HandTutor, ArmTutor and 3DTutor is used to improve shoulder, elbow, wrist and fine finger movement ability post stroke.

 

 

The indirect costs of Pediatric stroke

Research by Dr.Plumb from Children’s Medical Center in Dallas looks at the median out-of-pocket cost for the families in the first year following a pediatric stroke. These costs not covered by health insurance include lost wages, home care, transportation costs, and hotel rooms. Lost wages was seen to account for the largest percentage of the out-of-pocket costs.

From a clinical standpoint clinicians including physical and occupational therapists need to discuss with the patients family the impact of these indirect costs.

The research was supported by National Institute of Neurological Disorders and Stroke the Perot Center for Brain and Nerve Injury at Children’s Medical Center.

Telerehabilitation provided by the HandTutor, ArmTutor and LegTutor may help top limit the indirect costs of physical rehabilitation.