Posts Tagged ‘Medical Specialties’
In Archives of neurology Engelmann KY et al.Department of Neurology, Division of Pediatric Neurology Johns Hopkins University School of Medicine look at what outcome measures have been used in clinical trails to assess pediatric stroke study outcomes .
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.
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.
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.
Motor imagery is a well known practice that refers to mentally rehearsing motor acts instead of actual movement production.