Assisted active exercise practice and the HandTutor and ArmTutor

Occupational an physical therapists are using the MediTouch system in combination with active assistance. People with arm weakness can exercise their arms without assistance, but if their arms and hand movement ability is severely impaired, such exercise is difficult and compliance with exercise programs is low. Using the HandTutor and the ArmTutor the occupational therapist and the physical therapist can give the patient “assistance-as needed” to perform the required customized arm or finger a wrist exercise task. This clinical technique is known as active assisted exercise. During active assistance practice the patient actively contributes to the movement, this active exercise contribution is an essential feature of motor sensory and cognitive recovery and allows motor learning and plasticity. This means that the the HandTutor and ArmTutor can be used by patients with very little Active Range of Motion (AROM) as well as by patients with little ROM deficit.

Active assistance therefore allows OT and PT to use the MediTouch and provide their patients with severe deficits in AROM a customized exercise that gives immediate movement feedback and the enjoyment and motivation of video game based rehabilitation.

The MediTouch benefits patients with movement dysfunction or impaired functional activity caused by neurological disorders, including traumatic brain injury (tbi), stroke, cerebral palsy, spinal cord injury, and multiple sclerosis.

Computer-based cognitive rehabilitation (CBCR) after stroke

Computer-based cognitive rehabilitation (CBCR) effective on improving cognitive function after stroke. This conclusion was reached by occupational therapists from Department of Occupational Therapy, Semyung University, Jecheon, Republic of Korea. The group publish their results in NeuroRehabilitation, 04/16/2013.

The MediTouch HandTutor and ArmTutor work on improving motor sensory and cognitive movement ability through. The system is used in the clinic and at home and offers motivating customized exercise practice with OT and PT support.

Comparing the HandTutor to the Wii

The Wii is an example of a activity promoting video game (APVG). Practice with the Wii will increase recorded pulmonary ventilation (VE), oxygen consumption (VO2) and HR in normal uninjured subjects. Published in European Journal of Physical and Rehabilitation Medicine, 04/12/2013, Gaffurini P et al show that while practicing with the Wii Spinal cord injury (SCI) patients also saw an increase in energy expenditure (EE). The Physical and occupational therapists from the Laboratory of Neuromuscular Rehabilitation (LaRiN), University of Brescia, Italy conclude that APVG practice in subjects with SCI can be used to counteract deconditioning due to inactivity.

In contrast to exercise activity promoting video games, the HandTutor works with dedicated rehabilitation software that motivates the patient to do controlled finger exercise practice and improve their motor sensory and cognitive movement ability. This allows SCI patients to better do functional tasks. The MediTouch system  is a targeted rehabilitation systems that hones in on specific therapeutic goals. Through the enjoyment and motivation of game-based rehabilitation supported by the OT and PT the system addresses the challenge of impaired movement ability.

 

Post stroke treatment with botulinum toxin improves upper-extremity function

Writing in Archives of Physical Medicine Rehabilitation Dr. Foley and his team discuss that evidence from the literature shows that botulinum toxin type A (BTX-A) is associated with improvements in activity capacity or performance associated with poststroke spasticity in the upper extremity. Dr Foley and his team of physical and occupational therapists work at the Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital London, Ontario, Canada.

Physical neurological rehabilitation and observation or imagery of a motor action

Published in J Neuroeng Rehabilitation Dr. Holper and colleagues from the  University Hospital Zurich Switzerland shed insight into how neural networks located in the primary and secondary motor areas are activated during observation or imagery of a motor action investigated during neurorehabilitative training by physical and occupational therapists. The physical rehabilitation techniques of observation, imagery and imitation is also know as the simulation hypothesis  The research was funded by the Swiss Society for Neuroscience (SSN), the International Brain Research Organization (IBRO).

Augmented motion feedback training with the HandTutor, ArmTutor and LegTutor is thought to utilize the action-observation system as described by the simulation hypothesis and motivates the patient to perform repetitive and controlled intensive exercise practice in order to improve functional rehabilitation outcomes.

Predicting driving ability of stroke survivors

Published in topics in stroke rehabilitation Dr. Akinwuntan and his team from Department of Physical Therapy, Georgia Health Sciences University, Augusta, GA, USA discuss how to predict the driving performance of mildly impaired stroke survivors.

Because most stroke survivors that resume driving in the United States do so in the first year a valid predictive stroke Driver Screening Assessment tool (SDSA) is required. Therefore the group compared the predictive results of the United States version of the Stroke Driver Screening Assessment to driving performance in a high-fidelity driving simulator.

The group of physical therapists and occupational therapists found that the US version of the SDSA battery was a good predictor of driving performance of mildly impaired stroke survivors.

How to synchronize electrical stimulation with active movement to improve upper extremity function

electrical stimulation and stroke

Writing in the January edition of Brain Injury Dr. Inobe and his group from Rehabilitation Centre, Inobe Hospital , Nakao, Oita , Japan look at the effectiveness of finger-equipped electrode (FEE)-triggered electrical stimulation to improve upper extremity function in chronic stroke patients with severe hemiplegia.

It is well accepted that electric stimulation (ES) is an effective tool used by physical and occupational therapists to improve motor function in patients with severe UE function after stroke. It is also recognised that it is important for ES to be synchronized with voluntary movement or active movement ability.

One possibility is to allow the patients to trigger the ES. In this study, the trigger is on the patients finger so the technology is referred to as finger-equipped electrode or FEE triggered electrical stimulation.

This pilot study showed 4 patients and 3 controls. Each group underwent physical and occupational therapy treatment five times a week for 4 weeks. Both groups were assessed with the Fugl–Meyer Assessment (FMA) and Brunnstrom recovery staging.

The group that received the FEE triggered stimulation in addition to the traditional therapy showed a significant improvement in UE function.

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.

 

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.