Intensive rehabilitation techniques improves stroke outcome

Writing in US pharmacist, Dr. Osemene, Associate Professor of Pharmacy and Chair Texas Southern University College of Pharmacy and Health Sciences Houston, Texas USA  states that Rehabilitation remains the cornerstone to improve stroke sequelae outcomes. Stroke remains a leading cause of morbidity, mortality, and disability.

Neuromuscular Dysfunction  post stroke may include apraxia, pain syndromes, limb spasticity, and incontinence. Musculoskeletal pain in stroke patients is due to a dysfunction in functional movement ability and poor motor control, this is due both to improper limb and gait biomechanics and neurological impairments. The pain may be in the shoulders, hips, muscles, and other parts of the body.

Impacting the outcomes of stroke requires intensive rehabilitation techniques tailored to the patient’s needs and response.

The need for standardization in outcome measures following pediatric stroke

physical rehabilitation children

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 .

There is agreement among researchers, occupational and physical therapy clinicians that in order to maximize the comparability of future clinical trial results a preferred pediatric stroke outcome scale or battery of measures should be established. When searching the literature the group found that the most commonly applied outcome measure was the age-appropriate form of the Wechsler Intelligence Scale (WIS) that was used in 34% of studies. Second to this was the Pediatric Stroke Outcome Measure (PSOM) used in 21% of studies.

 

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.

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.

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.

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.

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.