Depression Post stroke

In a study published in Stroke, 03/28/2013 Dr. Ayerbe L et al from Kings College London discuss statistics that show that depression affects most of the stroke patients with episodes that have a short duration but a high risk of recurrence in the long term. For example the poststroke incidence of depression ranged from 7% to 21% in the 15 years after a stroke in London UK.

Multidisciplinary rehabilitation increases satisfaction of life in new SCI veterans

Published in Spinal cord in February Dr. Fortmann and his colleagues from San Diego State University/University of California working with the Veterans Administration Medical Center, San Diego look at satisfaction with life (SWL) outcome of new spinal cord injuries SCI patients completing multidisciplinary rehabilitation. The group found that increases in SWLS scores was noted during multi disciplinary rehabilitation including physical and occupational therapy rehabilitation.

 

Functional outcome of TBI improved by post acute physical therapy

Writing in PM&R (physical medicine and rehabilitation) Dr. Hayden and colleagues from Pate Rehabilitation, Dallas TX show that post acute rehabilitation undertaken at a postacute treatment facility is associated with functional gains for individuals with TBI over those that can be expected from undirected recovery. They also suggest that their findings provide evidence for postacute rehabilitation as the standard of care after TBI as all patients saw functional improvement regardless of time since injury. However, individuals admitted sooner after injury demonstrated the best functional improvement.

Spinal cord imaging following SCI

Dr Langston writing in world neurosurgery discusses how spinal imaging plays a critical role in the diagnosis, treatment, and rehabilitation of Spinal Cord Injury patients. He describes how new Imaging Techniques in Spinal Cord Injury spinal cord imaging techniques to SCI will allow for three-dimensional microstructural anatomy of the nerve fibre tracts which will yield information that will better enable predicting outcome and monitoring treatment response following spinal cord injury.

Postural control after stroke

 “postural control” is the control of the body  position or body stability in space during a functional movement. Postural control is often impaired following stroke. Several clinical scales and outcome measures can be used to quantify postural control. To do an assessment in postural control the patient is given several functional tasks involving posture in the sitting and standing positions as well a equilibrium in changing positions in lying, sitting and standing. For example, the functional tasks include supine to affected side lateral, supine to non affected side lateral, supine to sitting on the edge of bed, sitting without support, sitting to standing up, standing with support, standing without support, standing on the non paretic leg, standing on the paretic leg, standing, picking up a shoe from the floor, sitting down from standing up and sitting on the edge of bed to supine. Physical, physiotherapy and occupational therapy post will improve postural control.

Employment outcomes of adults with cerebral palsy

CP employment outcomes

Writing in the January edition of Disability Rehabilitation, Dr. Huang and colleagues from the Graduate Institute of Rehabilitation Counseling, National Changhua University of Education , Changhua , Taiwan look at Employment outcomes of adults with cerebral palsy in Taiwan. The group found that the employment rate for adults with CP is 22.9% with 67% of these individuals working in an integrated setting, 14% in supported employment, and 19% in sheltered employment.

The group consider that age, CP diagnosis, educational attainment, and functional performance all contribute to employment outcomes and suggest more research to determine which effective medical and vocational rehabilitation interventions improve employ ability of people with CP.

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.

Brain Stimulation Helps Parkinson’s Patients

There are several medications available to Parkinson’s patients to relieve their symptoms but when they aren’t effective a procedure called deep brain stimulation (DBS) is sometimes used. DBS consists of surgically implanting electrodes in deep brain structures that help control movement, and then delivering stimulation through the electrodes with a device very much like a pacemaker. One common target is the subthalamic nucleus (STN). The problem has been that although DBS can relieve movement problems it may incur problems in the patient’s cognition. Doctor’s do not fully understand the reasons for that.

A theory is being investigated by Dr. Joel Perlmutter, a professor of neurology and radiology at Washington University in St. Louis, Mo. to try to improve DBS and reduce its side effects. He has been targeting the stimulation to one particular site in the brain and avoiding another nearby site. Funding for the research is being provided from the National Institute of Neurological Disorders and Stroke through a recent congressional act called ARRA.

Studies show that stimulating the dorsal part (top) of the STN  can lead to desirable activity in the brain’s motor pathways, while stimulating the ventral part (bottom) can lead to negative activity in other brain pathways that are involved in cognition.

Dr. Perlmutter, together with his team, will examine Parkinson’s patients who have received DBS to the STN, and to try to pinpoint the location of the electrodes – which can possibly change after surgery. Their purpose is to  analyze how electrode location affects the  motor symptoms, cognitive function and cortical activity. In order to  locate the electrodes, the team instituted a method that involves reconstructing 2-D brain scans into 3-D maps, and then using landmarks in and around the STN for orientation.

From this research there should be a better understanding of how DBS works and improvements made in  treating Parkinson’s. This will include a better design and targeting of the electrodes. Besides that, the research is expected to yield insights into the function of the STN and how it is involved in other neurological disorders.

When Parkinson’s disease causes movement disorders physical therapy solutions become vital. The HANDTUTOR has been in the forefront of Parkinson’s patient exercise therapy for some time now. The HANDTUTOR consists of a safe comfortable glove with 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 opposition and pinch movement practice. The HANDTUTOR facilitates evaluation and treatment of isolated and combined finger/s and wrist joint.

Together with its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) the HANDTUTOR is currently in use in leading U.S. and European hospitals and rehabilitation clinics. They are fully certified by the FDA and CE and are available for use in the patient’s home through telerehabilitation.

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

Telehealth Comes of Age

What do the following have in common?

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

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

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

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

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

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

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

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

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

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

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

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

 

 

The ”Art” of Physiotherapy

Physiotherapy is the profession  that assists those who have basically three types of ailments.

1) Musculoskeletal conditions: sports injuries, arthritis, back pain,  muscle pain, bones and joints (also called orthopaedic physiotherapy). Some common conditions treated include  sprains, strains,  bursitis, workplace  problems with posture, incontinence and reduced mobility.

2) Cardiothoracic conditions: asthma, bronchitis, emphysema. Rehabilitation after thoracic surgery can also be offered.

3) Neurological conditions: MS, stroke, spinal cord injuries, Parkinson’s disease and multiple sclerosis. Rehabilitation after brain surgery is also in this category.

Physiotherapists are trained in a range of specialty areas such as children’s health (pediatrics),  women’s health or sports medicine. They can help speed recovery after certain surgeries as well.

The methods used include exercise programs, manual therapies and electrotherapy to restore proper functioning and to reduce the impact of dysfunction as described below.

Physiotherapy (physical therapy) aims to restore proper functioning to the body or, in the case of permanent disease or injury, to reduce the impact of any dysfunction.

Physiotherapists can also help a person  recover from surgery. Treatment options include a wide range of manual therapies and techniques such as: airway clearance techniques, tailored to  specific conditions. Physiotherapists  also show  how to acquire and use equipment aids.

The Physiotherapist may work in  private practices, community health centers, public hospitals, rehabilitation centers, fitness centers, sporting clubs,  schools and also in the workplace. He/she may work alone, or with other health care providers. Because they are registered health professionals, physiotherapists can issue sick leave certificates, if necessary.

A physiotherapist will want  to use a holistic approach to improve  mobility and health and help  to reduce the risk of injuries. In some cases injury is caused by a number of factors working together. For example,  back pain may  result from  a combination of poor posture,  overweight, repetitive work-related activities or an  incorrect technique when involved in sports.

The physiotherapist  treats the back pain, but at the same time wants to address the factors that contributed to the problem.

A physiotherapist uses a wide range of therapies, tailored to an individual need. They include:

Exercise programs – such as stretching, posture retraining, cardiovascular training and muscle strengthening .

Manual therapies – such as spinal mobilization, massage,  manual resistance training, stretching and joint mobilization /manipulation.

Electrotherapy techniques – such as diathermy, ultrasound, laser therapy and electrical nerve stimulation (TENS).

Other services – correcting flawed sporting techniques, taping and splinting  and providing information on equipment aids.

Physiotherapists  are university trained, registered health care professionals. They work in a variety of places including hospitals, private practice, rehabilitation centers, nursing homes and sports clubs.

When exercise is the preferred method of treatment the most effective physical therapy solutions and products should be used. These would be the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR.

 These recently developed  devices  have become a key system in neuro-muscular rehabilitation and physical therapy used by physiotherapists for interactive rehabilitation exercise. The TUTORs 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. This training is customized by the physiotherapist, occupational or  physical therapist to ensure that the patient stays motivated to do intensive repetitive manual therapy and exercise practice.  The TUTORs are now  part of the rehabilitation program of leading U.S. and foreign hospitals and are used in clinics and in the patient’s home through tele-rehabilitation.

Fully certified by the FDA and CE the TUTORs are usable by adults and children from the age of 5 and up. See WWW.MEDITOUCH.CO.IL for further information.