Hip fracture in Parkinson’s disease (PD)

Published in Movement Disorders, 02/26/2013 Dr. Walker compares the incidence and outcomes of Parkinson’s disease (PD) who suffer hip fracture compared to non PD patients in North East England. The team from the Department of Medicine, North Tyneside General Hospital, United Kingdom saw that PD patients had poorer mobility before hip fracture, had less mobility post surgery and took longer to be discharged into community physical rehabilitation. The team concludes that occupational and physiotherapists managing people with PD who sustain a hip fracture should be aware of potential complications of the condition to improve physical rehabilitation outcomes.

Neurological outcome and spinal cord injury

Spinal cord injury rehabilitation

Kalsi–Ryan S et al in the January edition of World Neurosurgery discuss how the use of functional tests such as the Spinal Cord Independence Measure, Functional Independence Measure together with neurological impairment measures e.g the International Standards for Neurological Classification and electrophysiological measures will provide more insight to the post physical rehabilitation outcome than either of the predictors taken alone.

 

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.

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.

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.

Chocolate Eater Makes Medical History

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.

Multiple Sclerosis Symptom Guidelines

People who develop Multiple Sclerosis (MS) are usually between 20 and 40 and display at least two symptoms before being seen by the doctor.

Blurred or double vision

Weakness in one or more limbs

Cognitive difficulties

Sudden onset of paralysis

Slurred speech

Lack of coordination

 Early symptoms of MS include:

Tingling

Loss of balance

Numbness

Later, as the disease progresses, other symptoms may appear such as fatigue, muscle spasms, sensitivity to heat, sexual disturbances and changes in thinking or perception.

Fatigue is typically present in the afternoon and may include increased muscle weakness,  mental fatigue, or sleepiness.  Many patients with MS complain of  fatigue even after a good night’s sleep.

Heat sensitivity which can worsen symptoms  occurs in most people with MS.

Spasticity. Muscle spasms are a common  symptom of MS. Spasticity  affects the muscles of the legs and arms, and may interfere with being able to move those muscles freely.

Dizziness. A feeling of “off balance” or lightheadedness or that the surroundings are spinning is common; this is called vertigo. These symptoms are due to damage in the complex nerve pathways that coordinate vision and  are needed to maintain balance.

Impaired thinking  occurs in about half of the people with MS. This can manifest itself by slowed thinking, decreased concentration, or decreased memory.  10% of people with the disease have it so severe  that they cannot carry out  tasks of daily living.

Vision problems can include blurring or graying of vision or blindness in one eye.

Abnormal sensations. Many  MS patients experience  sensations such as numbness, “pins and needles,”  burning, itching,  stabbing, or tearing pains. Even though these symptoms are aggravating, they are not life-threatening and can be  treated.

Speech and swallowing problems in people with MS are caused by damaged nerves that normally would aid in performing these tasks.

Tremors are fairly common in people with MS and can be debilitating and difficult to treat.

Difficulty walking is among the most common symptoms of MS.  This  is related to muscle weakness and/or spasticity.   Balance problems or numbness in the  feet can also make walking difficult.

There are other rare symptoms which include breathing problems and seizures.

 The symptoms can be divided into three categories: primary, secondary, and tertiary.

Primary symptoms are a result of the  impairment of the transmission of electrical signals to muscles  and the organs of the body.  These symptoms include: tremors, weakness,  tingling, paralysis, loss of balance, numbness, vision impairment and bladder or bowel problems. These can be kept under control through the use of medication and rehabilitation.

Secondary symptoms are a result of primary symptoms. For example, paralysis  can lead to bedsores  and bladder or urinary incontinence  can cause frequent urinary tract infections. Although these symptoms can be treated,  the ideal goal is to  treat the primary symptoms.

Tertiary symptoms include psychological, social,  and vocational complications that are associated with the primary and secondary symptoms. Depression can be a common problem for those  with MS.

Deterioration of the protective sheath (known as Demyelination) that surrounds nerve fibers, can occur anywhere in the brain or spinal cord.  Demyelination in the nerves that communicate with the muscles causes problems with movement (called motor symptoms) and demyelination along the nerves that carry  messages to the brain causes disturbances in sensation.

Multiple sclerosis is a varied and unpredictable disease. For many people, it starts with a single symptom, followed by months or longer without any progression of symptoms. In others, the symptoms can become worse within weeks or months.

There are many symptoms, as stated above, but it is important to know that a given individual may only experience some of the symptoms and not others. With some the symptom may occur and then disappear. It is not wise to compare one MS patient with another.

When the symptoms reach a level where physical rehabilitation can be helpful the most effective solutions should be incorporated into the patient rehabilitation treatment program. Such solutions would include the TUTORs. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients in rehabilitation centers,, private clinics and the home supported by telerehabilitation. The TUTORs have been used to create an intensive exercise program for patients who have had MS or stroke, Parkinson’s disease, head or brain injuries, CP and other upper and lower limb disabilities.

Currently in use in leading U..S. and European rehab facilities the TUTORs are fully certified by the FDA and CE.

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

Using Patient Goals in Treatment More Effective in Results

Brasilia, Brazil — It was found in a recent study that stroke patients found greater satisfaction if their progress was assessed on the basis of patient-specified goals.

According to Lisa Shaw, MD, senior research associate, Institute for Ageing and Health in Newcastle University in Newcastle upon Tyne, United Kingdom, one third of patient-driven goals was bimanual, i.e. assessing the function of both hands, which may have been the reason for  better outcomes than standard measures which may have missed that.

Using botulinum toxin-A (BT) in conjunction with a standard upper-limb therapy program, it was found that on objective measures of arm function following a stroke, neither therapy showed improved function after 1 month. However, patients stated they were equally satisfied with either therapy if satisfaction was based on attainment of goals that they had chosen themselves.

The original BT for Upper Limb after stroke  trial compared upper-limb therapy alone with therapy plus BT, It was found that using BT improved muscle tone after 1 month and a longer-term, arm strength, basic arm function tasks  and pain. But it didn’t improve arm function overall. BT has increasingly been used to reduce spasticity.

The investigators then asked the patients which therapy goals they would choose and how attainment of those goals compared with outcomes on a standard arm function test. They designed a  controlled, randomized clinical trial with (blinded) observers to look at arm function according to the Action Research Arm Test (ARAT), which consists of grip, grasp, pinch, and gross movement assessments vs patient-specified goal attainment, as assessed by COPM, the Canadian Occupational Performance Measure  which involves performance and satisfaction.

Participants were adults with upper-limb spasticity and reduced function at least 1 month after stroke. The average age was 68 years. 65% to 71% of patients were men and about 82% of participants had had a thrombotic stroke.

The interventions consisted of a 1-month upper-limb therapy program for 1 hour twice weekly with  or without  BT, when  outcomes were assessed. BT was injected into muscles of the hand, wrist, elbow, or shoulder depending the individual patterns of spasticity.

Treatments were focused on four set goals and one optional goal within the COPM. The focus was on passive, stretching; active assisted upper-limb movement; positioning; hygiene  and intensive task-oriented practice for ARAT.

The most commonly selected goals — about 90% of each group — were washing, dressing, eating and drinking. Participants chose goals of self-care (65%); productivity i.e. working in the kitchen, managing the household, going to school, playing or writing (19%); and leisure activities (16%). One third of the goals were bimanual tasks.

After 1 month, there were no  differences in the degree of improvement between the BT and the control groups. No change from baseline  on the ARAT occurred in either group.

Dr. Shaw said that despite the finding that BT did not enhance goal attainment or arm function compared with standard upper-limb therapy alone, both the BT and control groups had  relevant improvements of greater than 2 points on the COPM. ARAT measures are mostly unimanual, however many COPM measures involve both  the hands and arms. Dr. Shaw said the study shows the importance of including patient-specified goals when studying  rehabilitation.

Werner Hacke, MD, PhD, MPsych, professor and chairman of the Department of Neurology at the University of Heidelberg, Germany, agreed, saying ”It is about caring about the patient, and I believe it doesn’t matter what you do, if you care and you have a positive psychological impact on the patients, they will benefit, and they feel better. This is what is probably the most important thing about early rehabilitation — spending time with the patient, independent of what you do.”

He added that there is no proof that one or another physical therapy approach is better than another.

In stroke recovery finding the right physical therapy solution is vital. The TUTOR system of products provide an innovative method of providing an intensive exercise regimen to stroke survivors in rehabilitation of their affected limbs. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomically designed gloves and braces that consist of sensors connected to dedicated software. Physical and occupational therapists monitor the patient’s movement ability and then 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 available for adults as well as children from the age of 5 and up and can be used in the patient’s home through telerehabilitation.

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

 

Post ACL Surgery Rehabilitation Study

Charles P. Vega, MD, FAAFP , Washington University School of Medicine authored a study of  anterior cruciate ligament (ACL) rehabilitation strategies after surgery. The study was posted on  October26, 2012.

The anterior  cruciate ligament (ACL) is  one of the four major ligaments of the human knee.

There are about 80,000 ACL  injuries in the United States each year, according to a review by Waters (J Orthop Sports Phys Ther. 2012). These injuries are quite common among basketball players, with female players more frequently injured than male players. Also, more than half of basketball players who undergo ACL reconstruction may suffer either a tear of the ACL graft or a tear of the ACL of the contralateral knee within 5 years.

Because of the widespread nature of ACL injuries and reconstructive surgery, understanding the best practice for rehabilitation of patients after ACL reconstruction is critical.

The cornerstone of postoperative ACL rehabilitation is Range-Of-Motion, strengthening, and functional exercises. Bracing following ACL reconstruction has been found to be neither necessary nor beneficial,  did not improve pain or knee laxity and just adds to the cost of the procedure.

It is crucial for ACL surgery patients  to begin physical therapy early and rigorously. Although it can be difficult at first, it’s worth it in terms of returning to sports as well as  other activities according to  Rick W. Wright, MD, also from the Department of Orthopedic Surgery, Washington University School of Medicine.

The following are some of the results of the study:

On the basis of limited research, immediate postoperative weight-bearing, range-of-motion exercises from 0° to 90° of flexion, and closed-chain strengthening exercises after ACL reconstruction appear safe.

Eccentric quadriceps strengthening and isokinetic hamstring strengthening at 3 weeks after ACL surgery may improve strength more rapidly.

Home rehabilitation regimens can be very effective even though  there are limited data to support this conclusion.

Vitamin C and E supplements do not appear effective in helping patients after ACL reconstruction.

Hyaluronic acid injections to the knee administered 8 weeks post surgery may improve ambulatory speed and muscle torque.

Single-leg cycling can improve cardiovascular fitness after ACL reconstruction.

For post operative limb surgery such as ACL repair the most effective physical therapy solution should be incorporated into the rehabilitation program.

The recently developed LEGTUTOR by MEDITOUCH is one such product. The LEGTUTOR consists of a safe comfortable leg brace with position and speed sensors that precisely record three dimensional hip and knee movements. The LEGTUTOR has a range motion limiter that can limit the dynamic range of knee extension and flexion. Rehabilitation games allow the patient to exercise Range Of Motion, speed and accuracy of movement. The LEGTUTOR facilitates evaluation and treatment of the lower extremity including isolated and combined hip and knee movements.

Currently in use in leading U.S. and European hospitals and clinics the LEGTUTOR together with its sister devices (HANDTUTOR, ARMTUTOR and 3DTUTOR) are fully certified by the FDA and CE and can be used at the patient’s home through telerehabilitation.

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