Neuronal rearrangement and recovering of movement ability post stroke

Stroke may lead to various degrees of neurological deficit and long term upper and lower limb movement disability. Writing in  international Journal of Stroke, 04/09/2013 Dr. Varsou O et al Aberdeen Biomedical Imaging Centre, The University of Aberdeen, Aberdeen, UK discuss how functional connectivity magnetic resonance imaging may shed lights on neuronal plasticity following a focal brain injury.

Paralysis From a Non-Physical Source?

Arriving at the University Medical Center in Salt Lake City all the way from South Africa, the helicopter carrying Jeremy Clark landed noisily. Jeremy, a 23 year old college graduate had been on a Mormon religious mission for just a few weeks when he woke one morning to find that his legs were completely paralyzed. Doctors in S.A. were unable to find anything wrong with him medically.

Also not speaking made his examination process in Utah more difficult. Doctors were determined to get to the bottom of the problem and arranged for various tests to be performed. It was necessary to rule out diseases such as multiple sclerosis (ms); myasthenia gravis, a neuromuscular autoimmune disease that causes varying degrees of muscle weakness; Guillain-Barré syndrome, an acute condition associated with progressive muscle weakness and paralysis and stroke. A lumbar puncture to collect fluid from around the brain and inside the spinal cord had to be done to rule out infection.  

Then a full medical examination was conducted. Jeremy was a healthy and physically fit young man and his heart, lungs, abdomen, neurological exam, muscle tone all acted in a normal fashion. He was able to move his head, neck and arms without a problem but his legs would not move at all. More surprising was the fact that tapping his legs with a rubber hammer showed that there was no damage to the nerve path between muscles and spinal cord.

A stroke was ruled out as that usually would have affected only one side of the body. A discussion with Jeremy’s parents ruled out drug use or mental health problems. A doctor involved in the case was wondering whether Jeremy was ”faking” his symptoms and finally the staff psychiatrist was called in for an evaluation.

After another neurological exam the psychiatrist came up with a diagnosis of ”conversion disorder”. He explained that conversion disorder is an unusual psychological state with symptoms that resemble a neurological disorder or another medical condition. It usually begins abruptly and begins with a mental conflict or emotional crisis. Then it “converts” to a physical problem that prevents the patient from being involved in the activity that was causing him stress. There are a relatively small number of cases reported per 100,000 people and it is more common in women. Beginning at almost any age it usually occurs between the ages of 11 and 35. Aside from paralysis it can also cause amnesia, blindness, motor tics and other ”symptoms”.Usually the disorder will disappear spontaneously after 2 weeks of hospitalization and in some cases a physical illness is discovered later.

Jeremy was told about his condition, reassured that there was no physical disability and that he would recover very soon. After further routine questioning Jeremy broke down and and stated that he could not continue with the mission he was sent on. He didn’t like talking about religion with people. He was reluctant to come home because he thought he would let his parents or God down . This caused him enormous stress. The doctor informed him that no one could force him to go back. The situation was explained to his parents who agreed to get involved in his therapy sessions and rehabilitation. Within days Jeremy was walking the halls and was discharged from the hospital after making a complete recovery from the paralysis.

When a disease or surgery causes an incomplete paralysis of a limb or joint the most effective physical therapy solution should be found. Fortunately, a recent innovation has created the TUTOR system of products known as the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. The TUTOR system was developed to allow intensive exercise practice to those who have incurred a stroke, brain/spinal cord injury, MS, CP, knee/hip surgery or other type of upper or lower limb disabling event.

The TUTORs consist of ergonomically comfortable gloves or braces that are strategically placed and contain sensors connected to sophisticated exercise game programs. Physical or occupational therapists record and monitor the progress made and then design a specific exercise regimen for that patient. The TUTOR system is now in use in leading U.S. and European hospitals and clinics. Fully certified by the FDA and CE they are available for use at home through telerehabilitation and can be used by adults and children from the age of 5 and up. See WWW.MEDITOUCH.CO.IL for further information.

The Connection Between MS and Vitamin D

Researchers conducted a study that appeared in the Journal of Neurology, Neurosurgery and Psychiatry and published by the Jerusalem Post on December 23, 2012 in which they suggest that pregnant women take vitamin D supplements to ward of  MS, as not enough of the vitamin is produced in the skin from the sun’s ultraviolet rays. It has been a known fact that  MS can be contracted by people living in countries with little sunlight. The risk of developing MS is highest during April and lowest during October according to available analysis.

The researchers compared previously published data on almost 152,000 people with MS with expected birth rates for the disease in a bid to find out if there was any link between country of birth and risk of developing MS. At latitudes greater than 52 degrees from the equator, insufficient ultraviolet light of the correct wave length reaches the skin between October and March to enable the body to manufacture enough vitamin D during the winter months.

There was a significant increase in risk among those born in April and May and a significant lower risk among those born in October and November. The studies were only conducted in the northern hemisphere and that should be considered in this analysis.

The researchers state that through combining existing datasets for month of birth and subsequent MS risk, this study provides the strongest evidence to date that the month of birth effect is a genuine one. This supports previous hypotheses and adds weight to the argument for early intervention studies that recommended supplementing the diet with vitamin D to prevent MS.

When MS, nevertheless, develops its limb disabling symptoms the most effective physical therapy solution should be used. Such a solution can be found in the TUTOR system of physical therapy products.

 The recently developed HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) have become a key system in neuromuscular rehabilitation for stroke victims and those recovering from MS,brain and spinal injuries, Parkinson’s, 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 TUTORs consist of a wearable glove 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 rehabilitation 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 patient is given movement feedback that allows the patient to understand which effort is more successful in moving their affected limb again. The Tutor system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice.

The Tutor system is now part of the rehabilitation program of leading U.S. German, Italian, French, UK and other foreign hospitals. 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.

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.

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.

Motor Imagery As A Tool For Stroke Rehabilitation Improvement

Motor imagery is a well known practice that refers to  mentally rehearsing  motor acts instead  of actual movement production.

 A recent study was conducted to evaluate the effect of motor imagery  on the performance of sit to stand (STS) and reaching to grasp (RTG) in patients with post stroke chronic hemiparesis.

 The study was also designed as a crossover intervention. The participants were 13 people with a mean age of  68.9  with chronic hemiparesis that were enrolled in the day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and RTG, these functions were mentally practiced by the patients for 15 minutes three times a week for four weeks. Half of the subjects  practiced STS mentally, while the other half practiced the RTG imagery protocol. Then, the participants in each group switched over to practice the other function for the next 4 weeks. All of the sessions were performed under supervision according to a protocol that was established beforehand. Measurements of real performance took place two times before and two times immediately after each practice session. For STS, the Tetrax Balance System was the measure used to judge the speed of performance and the weight distribution between the legs. RTG was appraised by a “kinematic” glove which included speed variables of the hand.

The results of the study showed  a significant decrease  in the values of STS duration however weight distribution between the legs wasn’t  affected by the intervention. For RTG, a very significant improvement resulted both in the mean and the maximum reaching speed.

The conclusions reached by this study were that in individuals that have chronic hemiparesis, the practice of motor imagery   can positively affect real performance.

When physical therapy is indicated for stroke rehabilitation the TUTOR system has shown effective results. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomic wearable physical therapy products together with powerful dedicated rehabilitation software. The system is designed for upper and lower movement dysfunction. The TUTORs are designed to allow stroke patients intensive exercises in an entertaining and challenging fashion. Physical and occupational therapists monitor the progress of the patient and then design a customized exercise program.

Fully certified by the FDA and CE the TUTORs are currently in use in leading U.S. and European hospitals and clinics. They can also be used at home through telerehabilitation.

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

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

Step By Step Osteoarthritis Exercise Program

Always consult with your doctor before beginning an exercise program if you have osteoarthritis.

 

Stretching the Hamstring

 Walk for 5 minutes as a warmup.  Stretch. Lie down. Put a  bed sheet around your right foot and use it to help pull and stretch your leg up. Hold that position for 20 seconds. Repeat this twice, then switch legs. There are 3  important types of exercises for knee OA. Range of motion or stretching exercises which keep you limber. Strengthening exercises which build muscle strength in order to stabilize weak joints. Aerobic exercises, like walking, which help the lung and heart.

Stretching exercises help loosen muscles and improve flexibility. They also help prevent pain and injury.

While using a chair for balance, bend your right leg then step back with your left leg, slowly straightening it behind you. Press your left heel towards the floor. You will now feel the stretch in your back leg.

If you want more of a stretch then lean forward while bending the right knee deeper. However don’t let the right knee go past your toes. Hold this position for 20 seconds. Do it twice and then switch legs.

 Straight Leg Raise

 Lie on the floor and prop your back up on your elbows. Bend your left knee while keeping your foot on the floor. Keep the right leg straight with your toes pointed up. Tighten the thigh muscles of your right leg. Smoothly and slowly  use your thigh muscles — but not your back — to raise your leg.

Pause for five seconds. While your thigh is still tight, slowly lower your leg to the ground. Relax. Repeat this 10 times. Rest. Do another 10 sets; then switch legs.

Quad Set

If the straight leg raise is too tough then do quad sets instead. With these you don’t have to raise your leg. Just tighten the thigh muscles (quadriceps) of one leg at a time.

Begin by lying on the floor keeping both legs on the ground, relaxed. Flex and hold your left leg tense for five seconds and then  relax. Do 2 sets of 10. Then, switch to the other leg.

Seated Hip March

Doing this can strengthen hips and thigh muscles to help you with daily activities, like walking or getting up  from a chair.

Sit up straight in the chair.  Kick back your left foot but keep your toes on the floor. Lift your right foot off the floor while keeping your knee bent. Hold your right leg in the air for five seconds. Slowly lower your foot to the ground. Repeat this 10 times. Then rest and do another 10 after which you should  switch legs. If this is too hard use your hands to help raise your leg.

Pillow Squeeze

This will help strengthen the inside of your legs to give support to your knee. Lie on your back with both knees bent. Put a pillow between your knees.

Squeeze your knees together, squishing the pillow between them. Hold this for five seconds then relax. Repeat the set 10 times. Rest, then do another set of 10.

If this is too hard you can  do this exercise while seated.

Heel Raise

Hold the back of a chair for support. Stand straight and tall. Lift your heels off the ground and rise up on the toes of both feet. Hold it there for five seconds. Slowly lower both heels to the ground. Repeat this 10 times then rest and do another 10.

If this is too hard do the same exercise while sitting in a chair.

Side Leg Raise

Hold the back of a chair for balance. Place your body’s weight on your left leg. Lift the right leg outwards to the side. Keep your right leg straight. Keep your outer leg muscles tensed. Try not to slouch. Lower your right leg and relax. Repeat this 10 times. Rest. Do another 10 sets, then repeat  it with your left leg.

If this is too hard increase the leg height over time. Following a few workouts, you’ll be able to raise your leg higher.

Sit to Stand

Practice this move in order to make standing easier. Put two pillows on a chair. Sit on top of them, with your back straight and feet flat on the floor. While using your leg muscles, slowly and smoothly stand up tall. Then, slowly lower yourself back down to a sitting position. Make sure your bent knees don’t move in front  of your toes. Try this also with arms crossed  or loose to your side.

If this is too hard  add pillows or use a chair with armrests and then  help push up with your arms.

One Leg Balance

Try doing this hands-free or steady yourself on a chair, if necessary. Now, shift your body weight to one leg but don’t lock your knee straight. Then slowly raise the other foot off the ground, balancing on your standing leg. Hold that for 20 seconds then lower your  raised foot to the ground. Do this twice, then switch legs. This move helps you when getting out of cars or bending.

If you find this too easy, balance for a longer time. Or do it with your eyes closed.

Step Ups

This move can help you strengthen your legs for stair climbing. Face a stable step with both feet on the ground. First, step up with your left foot then follow with your right foot. Now, stand on top, tall and while both feet are flat. Climb down in the reverse order: Right foot down first, then left. Do this 10 times then rest and  repeat another 10 times. Now do it starting with your right leg first. If this is too  hard try using a railing, wall, a lower step or lamppost for balance.

Walking

If you have  stiff or sore knees you may not think that walking is a great idea but it actually is one of the best exercises for knee arthritis. Not only  can it reduce joint pain but it can also strengthen your leg muscles and improve flexibility. It’s also good for your heart and the best part is that there are no gym membership fees needed.

Having a good form is key: Look forward, keep your arms and legs moving, relaxed and walk tall.

Low-Impact Activities

Losing weight is a side benefit of being active and exercising. It also takes pressure off your joints. Other exercises that are easy on the knees are  swimming, biking and water aerobics. Water exercise can take weight off painful joints.

It isn’t necessary to give up your favorite activities, like golf. Discuss with  your doctor or physical therapist about modifying painful moves.

How Much Exercise?

Start with just a little. If there is no pain, do more next time. Try to aim for 30 minutes a day.

In the course of time you’ll build your leg muscles which will support your knee and increase flexibility.

It is normal to have some  muscle soreness  but hurting or swollen joints should have rest. Take a break and ask your doctor for advice. Ice painful joints and take ibuprofen, naproxen  or acetaminophen as a pain reliever.

Using physical therapy solutions and products is also an effective way to strengthen leg muscles which can alleviate osteoarthritis pain. The LEGTUTOR is one such device that can be used.

 The LEGTUTOR system is a key component of physical therapy used after total knee or hip  replacement and other knee and hip surgery. The LEGTUTOR is an ergonomic wearable leg brace with dedicated rehabilitation software.  The LEGTUTOR 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. This means that the LEGTUTOR system allows the physical therapist to prescribe a leg rehabilitation program customized to the patient’s knee and hip movement ability at their stage of rehabilitation. The LEGTUTOR uses biofeedback to keep the patient motivated to do the exercise practice with those that were designed in the form of challenging games. They are suitable for a wide variety of other neurological and orthopedic injuries and diseases as well as post trauma and orthopedic surgery.

 The LEGTUTOR is also used by physical and occupational therapists in combination with the HANDTUTOR, ARMTUTOR and 3DTUTOR for upper and lower extremity rehabilitation. The TUTOR system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. It is designed for children and adults and can be used at home supported by telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.