New Evidence for Therapies in Stroke Rehabilitation

A report in Current Atherosclerosis Reports, 05/03/2013 looks at the evidence based in medicine for physical therapy interventions to promote Neurologic rehabilitation post stroke.

The report by Dobkin BH et al. from Department of Neurology, Geffen School of Medicine, University of California Los Angeles, CA, USA shows that persons with serious stroke do return to participation in usual self-care and daily activities as independently as is feasible. The physical and occupational therapy detailed includes progressive task-related practice of skills, exercise for strengthening and fitness, neurostimulation, and drug and biological manipulations. The group also discuss how intensive practice can induce adaptations at multiple levels of the nervous system which lead to neuroplasticity and functional improvement.  The group discuss recent clinical trials to manage walking, reach and grasp, aphasia, visual field loss, and hemi-inattention.

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.

Functional magnetic resonance imaging and neuroplasticity correlate to hand function

Published in Neuroradiology Feb 2013 Dr. Yin discuss neuroplasticity and the relationship between functional reorganization and outcomes in hand function after subcortical stroke. The group from Shanghai Key Laboratory of Magnetic Resonance, Key Laboratory of Brain Function Shanghai China use Functional magnetic resonance imaging (fMRI)

Plasticity targets for physical and occupational therapy after brain injury

Dr. Kirton from the Calgary Pediatric Stroke Program at Alberta Children’s Hospita, Department of Pediatrics and neurology looks at a model of plastic motor development after perinatal stroke that causes motor disability  and hemiparetic cerebral palsy. The research aims at finding therapeutic targets that can be used to direct evidence based physical and occupational therapy rehabilitation techniques and improve rehabilitation outcomes after brain injury.

What is Rehabilitation of a Spinal Cord Injury?

The spine shown here with spinal cord. (Photo credit: Wikipedia)

When treating a person who has a spinal cord injury, the ultimate goal is repairing the damage created by the injury. Treatment should not be limited to one method as greater improvements are achieved with a variety of methods. Furthermore, increasing activity will increase  recovery. The rehabilitation process after a spinal cord injury begins in the acute care setting. Physical therapists, occupational therapists, social workers, psychologists and other health care professionals work as a team to decide on goals with the patient and develop a plan of discharge that is appropriate for the patient’s condition.
The amount of time a patient is immobilized may depend on the level of the spinal cord injury. Physical therapists work with the patient to prevent any complications that may arise .Other complications that arise from immobilization are muscle atrophy and Osteoporosis, especially to the lower limb, increasing the risk of fractures to the femur and tibia. While passive weight bearing of paralyzed lower extremities appears to be ineffective, stressing the bones through muscular contractions initiated by functional electrical stimulation (FES) have yielded positive results in some cases. Generally, the frequency is effective with three or more weekly exercise sessions. Studies of duration suggest that several months to one or more years of FES are necessary. Improvement of locomotor function is one of the primary goals for people with a spinal cord injury. SCI treatments may focus on specific goals such as to restore walking or locomotion to an optimal level for the individual. The most effective way to restore locomotion is by complete repair, but techniques have not yet been developed for regeneration. Treadmill training, over groundtraining, and functional electrical stimulation can all be used to improve walking or locomotor activity. These activities work if neurons of the central pattern generator (CPG) circuits, which generate rhythmic movements of the body, are still functioning. With inactivity, the neurons of CPG can degenerate. Therefore, the above activities are important for keeping neurons active until appropriate regeneration activities are developed.   As a team, health-care professionals help to re-orient the patient, provide support for the patient and family, and begin to develop goals with the patient.

Occupational therapy plays an important role in the management of SCI. Recent studies emphasize the importance of early occupational therapy that is begun immediately after the client is stable. This process includes teaching of coping skills, and physical therapy. In the first step, acute recovery, the focus is on support and prevention. Interventions aim to give the individual a sense of control over a situation in which the patient probably feels little independence. As the patient becomes more stable, they may move to a rehabilitation facility or remain in the acute care setting. The patient begins to take more of an active role in their rehabilitation at this stage and works with the team to develop reasonable functional goals. Though rehabilitation interventions are performed during the acute phase, recent literature suggests that 44% of the total hours spent on rehabilitation during the first year after spinal cord injury, occur after discharge from inpatient rehabilitation. Participants in this study received 56% of their total physical therapy hours and 52% of their total occupational therapy hours after discharge. This suggests that inpatient rehabilitation lengths of stay are reduced and that post-discharge therapy may replace some of the inpatient treatment.

One of the newest physical therapy products to achieve the above goals is the TUTOR system. This set of devices  (HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR) has been developed to achieve renewed mobility to affected limbs which have been disabled due to spinal cord or brain injury, Parkinson’s disease, CP, MS,stroke, head injuries Radial/Ulnar nerve injuries, Brachial Plexus injuries and other upper or lower surgery disabilities. The HANDTUTOR is an ergonomic glove and the ARMTUTOR, LEGTUTOR and 3DTUTOR are comfortable braces that are attached to the specific limb and then connected to customized software where th epatient conducts intensive exercises with exclusively created games. These games are challenging and allow the patient to develop usage of his affected limb. Through the use of telerehabilitation the patient can even accomplish this exercise program at home if he is located too far from a rehabilitation facility. Physical/occupational therapists respond and record  the patient’s progress in order to create a customized exercise program appropriate to that particular patient.

The TUTOR system is now in use in leading U.S. and European hospitals and clinics. They are FDA and CE certified. See WWW.MEDITOUCH.CO.IL for more information.

TBI Criteria of the U.S. Social Security Disability Benefit Program

There are 5 criteria that are used by the U.S. Social Security Administration to determine the need for disability assistance if a person has suffered a Traumatic Brain Injury (TBI)

1.  Is the individual earning more or less than $1010 per month from employment. More will disqualify him.

2.  The TBI has to be severe enough to affect the patient‘s walking, sitting, lifting, reaching, pushing, standing, pulling,  carrying or handling, seeing, hearing and speaking, understanding/carrying out and remembering simple instructions, responding appropriately to supervision and more.

3. The disability has to  meet or equal a medical listing listed under neurological disorders. Sometimes the actual severity of a mental impairment may not become apparent until six months post-injury thereby postponing the financial benefit payment.

4. If a person is able to do work that he had done previously he may be denied any benefits.

5.  A review is conducted of age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform.

When someone suffers a traumatic brain injury and it is determined that there is a reasonable chance of recovery the TUTOR system should come into play.

Victims of brain injury and stroke can benefit greatly from the  Tutor system which consists of the HANDTUTOR, ARMTUTOR, LEGTUTOR and the 3DTUTOR. The TUTOR system is one of the newest physical therapy solutions and is being used successfully in leading U.S. and foreign hospitals and clinics. It is also benefiting home care patients through the use of telerehabilitation.

 The newly developed  physical therapy products   have become a key system in neuromuscular rehabilitation and physical therapy for brain injury patients including, post stroke and TBI. These innovative tools implement an impairment based program with augmented feedback  that encourage practice and motor learning through intensive active exercises. The exercises are challenging and motivating and are tailored to the patient’s performance and motor and sensory and cognitive movement ability.

Customized simple and powerful rehabilitation software allows the physical and occupational therapist  the ability to adjust the program and exercise difficulty to the patient’s movement ability. The system also includes objective quantitative evaluations that allow the physiotherapist and his occupational therapist colleagues to report on the patient’s exercise progress. Telerehabilitation features allow the HANDTUTOR, LEGTUTOR, ARMTUTOR and the 3DTUTOR to be supported by the physical rehabilitation team when the patient is at home. This ensures that the patient is motivated to do more practice between treatments by the therapists.  The TUTOR system is suitable for children as well as adults.

See WWW.MEDITOUCH.CO.IL for more information

Internet Based Versus Conventional Physical Therapy

A study conducted by T.G. Russell, P. Buttrum, and R. Wooton etal in 2011 used a 6 week, 65 participant patient base for looking at a comparison of a group using  telehealth physical rehabilitation versus  another conventional therapy   group. The outcomes for flexion, extension, range of motion, muscle strength, limb girth, pain, quality of life and clinical test scores were the same for Internet based therapy (IBT) as for the conventional group. The study thus advocates for an investigation of cost reduction and comparative effectiveness for consumers of telehealth in physical therapy solutions.

One of the best and most cost effective physical therapy products on the market today is the TUTOR system. This physical therapy solution also includes the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are gloves or braces that are attached to affected disabled limbs with sensors to a dedicated and exclusive software program. The patient with some paresis stemming from Parkinson’s disease, stroke, brain/spinal cord injury, CP, MS or other limb disabling illnesses or surgeries is able to be involved in an intensive exercise program. The attending physical/occupational therapist  then records the information and customizes the treatment session to fit the patient’s needs. This creates augmented feedback leading to enhanced functional rehabilitation. All this is available as a physical therapy solution through the use of telerehabilitation where the patient either has improved to the point that he doesn’t need hospitalization care or where he may be located too far from a rehabilitation facility.

For more information on the TUTOR system see WWW.MEDITOUCH.CO.IL             

Footdrop (Dropfoot) and its Treatment

“Dropfoot” or as it is sometimes called “Footdrop” is the inability to raise the front part of the foot sometimes dragging it along. Although it is not a disease in itself it emanates from any number of other physical issues ranging from injury to spine or leg muscle. The treatments range from accupuncture to surgery. Physicians around the world have suggested many different approaches.

One of the most effective physical rehabilitation solutions produced involves the use of the LEGTUTOR.

The LEGTUTOR system is a key component of physical therapy for dropfoot and other lower limb disabling medical issues. The LEGTUTOR physical rehabilitation product is an ergonomic wearable leg brace with dedicated rehabilitation software.  The LEGTUTOR  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 foot,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 of rehabilitation products is used by many leading physical therapy 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.

Brachial Plexus Injuries and Their Recovery Possibilities

There is a group of nerves at the base of the neck called  Brachial Plexus. It is  responsible for conducting nerve signals from the spinal cord to the shoulder, arm, and hand. When the Brachial Plexus is injured  physical therapy exercises  help heal damaged nerve fibers. Normal nerve function can usually be restored by a range of motion exercises.

 

It is important to diagnose the severity of damage. Signs of Brachial Plexus injury include weakness or numbness of the arm or hand, or sharp pains that may radiate down the arm.  The severity of a Brachial Plexus injury may range from mild inflammation to a complete rupture of the nerve roots.A more extreme injury may leave the arm and shoulder completely paralyzed.For less severe cases, physical therapy may be the answer to healing the injury and regaining normal sensation and mobility.

 

Range of motion exercises are extremely important to healing the damaged nerves of brachial plexus. These therapeutic exercises facilitate nerve signaling and conduction, as well as promoting an increase in blood flow to the injury, allowing the damaged sites to heal faster. Exercises such as shoulder flexion, extension, and rotation are important to improve muscle function of the upper arm. Supination and pronation of the forearm and circumduction of the wrist is good for joint mobility.

 

Because of the nature of the cells that make up nerves, it may take some time to heal the injury. Nerve regeneration can  take up to four months. It is important to practice patience during the healing time, and to remain active in the physical therapy program to restore optimal arm and hand function.

 

In the forefront of physical rehabilitation of the Brachial Plexus is the TUTOR system. As part of  physical rehabilitation solutions these TUTOR products (HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR) have shown remarkable progress in restoring normal movement ability to affected limbs.

 

Most of the therapy solutions now in use consist of an outside stimulus or force to cause movement of the affected limb. The TUTORS  use a more natural system. The patient does the work not a machine or robot. The patient thus learns how to reuse his limb rather than relying or waiting for an independent stimulus. This system has a much preferred lasting effect and also challenges the patient to do more for himself. In addition the TUTORS do assisted active exercise by the PT or OT which is vastly less expensive than a robot. The OT or PT is also multi tasked and can assist the patient in intensive repetitive exercises.

 

The TUTOR system consists of ergonomic wearable devices together with powerful dedicated rehabilitation software and is indicated  for patients who have head, trunk, upper and lower extremity movement dysfunction and are in rehabilitation centers, private clinics and the home where it can be supported by telerehabilitation.

The system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. Controlled exercise practice will help to prevent the development of compensatory movement patterns. The dedicated software allows the therapist to fully customize the exercises to the patient’s movement ability. In addition the therapist can objectively and quantitatively evaluate and report on the treatment progress. The TUTOR system optimizes the patient’s motor, sensory and cognitive performance and allows the patient to better perform everyday functional tasks to improve their quality of life. The TUTOR system is FDA and CE certified. See WWW.MEDITOUCH.CO.IL for more information.

 

Traumatic Brain Injury and its Treatment Cost

Traumatic brain injuries are the cause of a substantial number of deaths and permanent disabilities. Some of them are seen. Others are not.  The Centers for Disease Control and Prevention says that each year 1.7 million people sustain a traumatic brain injury; 52,000 people die while 275,000 are hospitalized. TBIs represent a third of all injury-related deaths in the United States. The numbers are rising fast, because we know more about sports injuries and because of our injured troops in wars. In March 2012, at a news conference about Brain Injury Awareness Month, the Pentagon put the number as high as 360,000 Iraq and Afghanistan veterans who may have suffered brain injuries. Among them are up to 90,000 veterans whose symptoms still persist and require specialized care.

A TBI is caused by a blow, jolt, bump, or penetration to the head that disrupts  normal functioning of the brain. The severity can range from ” a brief change in mental status” to  ”extended unconsciousness” or amnesia after the injury. Even after “recovery” many survivors cannot return to what they used to do or find other work.  The Brain Injury Alliance of Oregon calculated that a survivor of severe brain injury necessitates an expense of between $4.1 million and $9 million in lifetime care.

The TUTOR system is a physical therapy product for physical rehabilitation is one of the most COST EFFECTIVE  medical devices to come on the market recently.

The HANDTUTOR, a glove, for hand therapy; the ARMTUTOR, an arm brace, for arm/shoulder therapy; the LEGTUTOR, a leg brace, and 3DTUTOR for leg/hip therapy are tools for intensive active exercises that have proven beneficial in traumatic brain and spinal cord injury  rehabilitation.

Intensive exercise practice has been proven to improve functional movement ability following orthopedic and neurological injury (including SCI and brain injury) as well as disease. Patient motivation and control of the exercise practice are the fundamental factors required for optimum functional recovery and prescribed by occupational and physical therapists. Traditional practice is mostly based on low technology tools that intrinsically lack features to challenge and motivate the patient to do intensive exercise training. This is why biofeedback and motion feedback are the tools of choice to give a physical therapy solution that offers motivating and controlled manual therapy.

The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are suitable for telerehabilitation.
See WWW.MEDITOUCH.CO.IL for more information.