Writing in the Archives of Physical Medicine and Rehabilitation, 04/05/2013 Dr. Rose DK et al look at the predictive power of the results of Exercise Tolerance Testing and the 6MWT (six minute walk test). The group compare the scores to the number of physical therapy rehabilitation sessions – treadmill and overground Locomotor Training Program (LTP), needed to achieve 20 minutes stepping duration in these patients. ETT is a measure of cardiac performance where as 6MWT is more a measure of neurological impairment and muscular condition.
Posts Tagged ‘Physical medicine and rehabilitation’
Reporting in Physical Therapy, Dr. Ellis and his team from the Department of Physical Therapy & Athletic Training, College of Health & Rehabilitation Sciences Boston University USA look at the barriers to exercise in people with Parkinson Disease (PD). Although exercise is known to reduce disability and improve quality of life in persons with Parkinson disease (PD). The group conclude that low outcome expectation of exercise, lack of time to exercise, and fear of falling are important barriers to engaging in exercise among ambulatory, community dwelling persons with PD.
Dr Winstein and her colleagues working from several sites in the US present their protocol for a randomized controlled trial called an Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE).
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.
A 52 year old woman, named Jan Scheuermann, ate chocolate after a brain operation. So what? One might ask. However this simple act made history because Jan is paralyzed from the neck down
Originally diagnosed with a degenerative brain disorder 13 years prior doctors implanted tiny electrodes in her brain which allowed her to operate a robotic arm.
Jan’s ultimate wish was to feed herself chocolate once the electrodes had been in place.
Doctors, led by Professor Andrew Schwartz of the University of Pittsburgh Medical Center, applauded her feat.
The arm is a prosthetic controlled directly by the brain and this achievement marked a major step for people who are unable to move their own arms.
“Our study has shown us that it is technically feasible to restore ability and gives patients hope for the future”, said Dr. Schwartz.
The two microelectrodes were implanted into Jan’s left motor cortex. This is the part of the brain that initiates movement.
A scanning technique called ”functional magnetic resonance imaging” (fMRI) located the part of the brain that lights up when the patient is asked to think about moving her paralyzed arms.
The electrodes were connected to the robotic hand through a computer which ran an algorithm to translate the signals that imitates the way an unimpaired brain is able to control healthy limbs.
Decoding human motion has no limit now. It is quite complex when one works on parts like the hand for example, but once the desired motion is tapped how that motion will be effected has a wide range of possibilities according to the medical researchers.
For those brain injured patients that still have arm mobility the ARMTUTOR and HANDTUTOR offer an effective physical therapy solution.
The ARMTUTOR™ and HANDTUTOR systems have been developed to allow for functional rehabilitation of the upper extremity including the shoulder, elbow and wrist. The system consists of an ergonomic wearable glove and arm brace together with dedicated rehabilitation software. The ARMTUTOR™ and HANDTUTOR systems allow the physical and occupational therapist to report on and evaluate the patient’s functional rehabilitation progress. This allows the PT and OT to prescribe the correct customized and motivating intensive exercise practice to the manual rehabilitation therapy. Intensive repetition of movement is achieved through challenging games set to the patient’s ability. The system provides detailed exercise performance instructions and precise feedback on the patient’s efforts. Controlled exercise of multijoints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks. Telerehabilitation allows the recovering patient to continue his physical therapy at home. The system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.
See WWW.MEDITOUCH.CO.IL for more information.
What do the following have in common?
Rural areas, medical insurance companies, 200,000 patients, cardiac patients, mental health patients, neurological telehealthdisease patients, suicide prevention and oncology follow-up care. An unlikely group of terms? Not if you consider that all of these derive a benefit or support from TELEHEALTH. In this age of high technology many medical procedures and benefits can be accomplished remotely and with as much expertise as with a face to face encounter with a professional.
Today, telehealth is fast taking its place as a major aspect of healthcare and is understood more than ever before.