Treating Pediatric Movement Disorders

A child’s brain has a remarkable ability for reorganization. In other words  even after a significant injury, uninjured parts of the brain can take over some or all of the function of the damaged parts.  Neurons do not generally re-grow and therefore “plasticity” or reorganization   is probably the major mechanism by which children improve or recover after a brain injury.  It is likely that plasticity plays an important role in maximizing the child’s abilities even in progressive or degenerative diseases.

It is likely that plasticity mechanisms are significantly enhanced by appropriate exercise, although there is not yet conclusive evidence about that. Therefore schooling, physical therapy and occupational therapy are important not only to improve strength and teach skills, but  to help the brain relearn and adapt to its injury as well. This may be particularly true with movement disorders, since a child can be able to learn alternative strategies for movement that utilize use of residual neurological and musculoskeletal function. At  a minimum, by maintaining joint mobility and preventing muscle contracture, occupational and physical  therapy preserve the ability for a child to  use these muscles and joints in the future.

Evidence from research in  humans and animals shows that the brain can adapt rapidly (even over a period of a few weeks) to changes in the use of  limbs. In regards to childhood movement disorders common physical and occupational therapy aims at intensive exercise practice to train the appropriate use of  limbs as soon as possible after the event. Thus intensive early and customized manual therapy will have long-term benefits and improve functional movement ability outcome.  In addition early intensive training will postpone or prevent future worsening of symptoms.

When deciding how to administer the most efficient method of therapy it is important to use the physical therapy solution that can be customized to the patients movement ability even if this movement ability is badly impaired after the event. The TUTOR physical therapy products have now been used successfully in leading U.S. and European rehabilitation hospitals and clinics to administer intensive exercises to both adults and children who have limb movement disorders in both the acute and chronic phase post event. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR consist of ergonomically designed gloves and braces with sensors connected to sophisticated and challenging software that allow the patient to practice isolated and/or interjoint coordination exercises. The system then provides the therapist with the patient’s motor, sensory and cognitive progress.  Subsequently a customized exercise program is formulated for that patient.

Fully certified by the FDA and CE the TUTORs are also available in the patient’s home through telerehabilitation.

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

Dupuytren’s Contracture (DC), A Hand Disorder– Its History and Treatment

Dupuytren’s contracture (DC) is a condition consisting of a shortening and thickening of the palm’s tissue which results in clawing of the fingers. Its cause is unknown, but  is thought to be hereditary. Other causal factors may include advancing age and  conditions, such as diabetes, alcoholism  and epilepsy. Treatment may include a range of therapies, surgery and exercises.

The hand palm  contains a  layer of tissue called the palmar fascia, which reaches across the palm to the fingers. DC is a thickening and shortening of this web of fascia that gradually can cause clawing of the fingers because they are pulled towards the palm. Any finger can be affected but the ring and little finger are usually affected.

DC tends to progress in an on and off method, and may take years to finally limit the functioning of the hand. The  cause of the disease is unknown, but it usually occurs among certain groups which include:

DC can sometimes run in families,  suggesting a genetic component. The type of treatment depends on the severity of the condition, but could include injections of corticosteroids into the hand and surgery.

Features of DC include:

A lump or nodule  on the palm, which usually appears close to the bottom of the ring or little finger.

There is what appears to be a thickened cord  along the palm to the fingers.

In time,  the fingers become clawed because they are pulled towards the palm.

The hand bows, the fingers are  pulled against the palm and the skin of the palm is dimpled and puckered..

There is rarely any associated pain.

Contributing factors to the  exact trigger are unknown. However, they may include:

Heredity – the condition tends to occur in families.

Ancestry –  Celtics or Scandinavians  are at  an increased risk.

Age – the condition occurs more  in middle to later years of life.

Gender – almost 10 times more men than women are affected.

Alcoholism – the contracture seems to be more severe in alcoholics.

Certain medical conditions – people who have diabetes and epilepsy have a higher incidence of DC.

Although in most cases, only the hands are affected other associated difficulties can include:

Garrod’s pads – the  joints of the finger on the same hand may enlarge and become thick.

Peyronie’s disease – there may be thickening and shortening of penis tissue .

Ledderhose disease – creates thickening and shortening  of deep connective tissue on the foot. As the disease progresses, this can cause  severe pain while walking.

The type of treatment depends on the severity of the condition. In its initial stages, treatment may include injections of corticosteroids into the fascia. These medications can reduce  localised tenderness and may  delay subsequent thickening of the tissue.

Other treatments include calcium channel blockers,  percutaneous needle fasciotomy and treatment with gamma-interferon.

If as in severe  cases, the person is unable to lay their hand palm-down on a flat surface, or their fingers have contracted into their palm so that the hand is no longer functional surgery may be indicated. DC can sometimes return after surgery, either at the same place or somewhere else on the palm.

The surgery options may include:

Cutting the fascia bands through small incisions in the palm

Removing the fascia and associated skin, and using a skin graft to seal the palm

Amputation of an affected finger, if the problem has returned so many times that corrective surgery is no longer a viable alternative.

Occupational therapy is necessary after surgery in order to speed recovery and reduce any risks of the contracture returning.

Specific techniques may include:

A splint worn during daytime.

A splint worn at night for several months in order to straighten the finger

Special hand exercises to encourage flexibility

Massage with moisturising hand cream.

When exercising the hand is indicated the use of the HANDTUTOR will afford excellent intensive exercises for the patient. The HANDTUTOR is a safe comfortable ergonomically designed glove containing 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 including opposition and pinch movement practice.

Currently in use in leading U.S. and European hospitals and clinics the HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) 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 at home through telerehabilitationDC.

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

Motor Imagery As A Tool For Stroke Rehabilitation Improvement

Motor imagery is a well known practice that refers to  mentally rehearsing  motor acts instead  of actual movement production.

 A recent study was conducted to evaluate the effect of motor imagery  on the performance of sit to stand (STS) and reaching to grasp (RTG) in patients with post stroke chronic hemiparesis.

 The study was also designed as a crossover intervention. The participants were 13 people with a mean age of  68.9  with chronic hemiparesis that were enrolled in the day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and RTG, these functions were mentally practiced by the patients for 15 minutes three times a week for four weeks. Half of the subjects  practiced STS mentally, while the other half practiced the RTG imagery protocol. Then, the participants in each group switched over to practice the other function for the next 4 weeks. All of the sessions were performed under supervision according to a protocol that was established beforehand. Measurements of real performance took place two times before and two times immediately after each practice session. For STS, the Tetrax Balance System was the measure used to judge the speed of performance and the weight distribution between the legs. RTG was appraised by a “kinematic” glove which included speed variables of the hand.

The results of the study showed  a significant decrease  in the values of STS duration however weight distribution between the legs wasn’t  affected by the intervention. For RTG, a very significant improvement resulted both in the mean and the maximum reaching speed.

The conclusions reached by this study were that in individuals that have chronic hemiparesis, the practice of motor imagery   can positively affect real performance.

When physical therapy is indicated for stroke rehabilitation the TUTOR system has shown effective results. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomic wearable physical therapy products together with powerful dedicated rehabilitation software. The system is designed for upper and lower movement dysfunction. The TUTORs are designed to allow stroke patients intensive exercises in an entertaining and challenging fashion. Physical and occupational therapists monitor the progress of the patient and then design a customized exercise program.

Fully certified by the FDA and CE the TUTORs are currently in use in leading U.S. and European hospitals and clinics. They can also be used at home through telerehabilitation.

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.

Too Much Alcohol, Being in Love As A Cause For Wrist Drop and its Treatment

Wrist drop, which is also known as Saturday night palsy, radial neuropathy or radial nerve palsy,  is a condition where a person cannot extend their wrist and it hangs down loosly or  flaccidly. A person with wrist drop would be unable to move his wrist from that to a normal or neutral straight position .

Drunkenness and being in love have something in common. Both  may result in an injury called radial neuropathy which can  produce this  ”wrist drop’” condition.

Waking up to find that your hand is ”dead” is why this condition is nicknamed Saturday Night Palsy or Honeymooner’s Palsy.

In Wrist drop  you may feel sensation in the hand, yet not be able to move your hand or fingers one millimeter.

 Causes 

Though there are various causes of wrist drop it frequently results from a compression injury that includes damage or death of radial nerve cells within the arm.

Pain is usually  a warning sign before radial neuropathy develops as the arm builds up pressure over an extended period. But, the pain may be unnoticed, or even ignored, when one is in an intoxicated stupor.

An example would be sleeping on your extended arm or having it swung over a chair after consumption of alcohol, hence the name Saturday Night Palsy. Another example is when one lover falls asleep on the arm of the other and head pressure compresses and thereby damages the radial nerve.

Wrist Drop Diagnosis

Usually an MRI and a neurological consult is how a diagnosis would be made in order to determine the extent of damage but also to rule out other possibilities like carpal tunnel syndrome.

Recovery from Wrist Drop

A doctor may be able to predict if there will be a long or short recovery period but he will not be able to quantify it in days, weeks or months. The nerves may heal gradually and movement may be restored. The wrist may heal faster than the fingers. Nerve cell destruction will make the healing time even longer until regeneration can occur.

Treatment for Wrist Drop

While using a hand splint and the healthy hand for support together with a proper diet may help there is no real treatment for wrist drop. However daily exercising is recommended to keep the tendons and muscles from tightening and atrophy.

Fortunately, today there are physical therapy solutions that can provide an excellent exercise program that can begin to alleviate symptoms  leading to complete recovery. The HANDTUTOR by MEDITOUCH is one such product that is in use today for other limb disabling issues but that can be adapted as well to wrist drop. The HANDTUTOR, specifically, can be used to actively exercise extensor muscles of the wrist and therefore strengthen it so the hand does not drop.
The HANDTUTOR together with its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) was originally  created to provide an intensive exercise system for patients recovering from a stroke, brain or spinal injury, Parkinson’s, MS, CP, knee and hip replacement surgeries and other upper or lower limb disabilities.

The TUTOR system consists of ergonomically designed gloves or braces containing sensors connected to dedicated software. Physical and occupational therapists monitor the progress and design a customized exercise program for that patient. The TUTORs are one of the most cost effective limb exercise products available. They are fully certified by the FDA and CE and can be used by adults and children from the age of 5 and up. The TUTORs can also be used at home through telerehabilitation.

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

Balance Maintaining Techniques

 

 

Here are some simple, everyday activities that can strengthen your balance as suggested by Harvard Medical balanceSchool.balance

 Those that love running, tennis, dancing, golf or any number of other sports or activities know that working on balance buffs your abilities. However if you are not an athlete then just walking across the room or down the block may challenge you to have  good balance. The same applies to rising from a chair, going up or down stairs, carrying packages, and even turning around to see who is behind you.

 Good balance helps prevent potentially disabling falls.

 It doesn’t take special fitness classes or exercises to preserve and improve your balance. If you incorporate balance and strength activities into your daily routine that could be enough to keep you from falling.

A research group in Australia tested a simple program called ”Lifestyle integrated Functional Exercise” (LiFE) for a group of 317 people who were  70 and older  and who had fallen in the previous year. The participants were randomly assigned to one of 3 groups: the LiFE program, a control “sham” program of gentle exercises and a structured exercise and strengthening program.

Those in the LiFE program incorporated balance and strength movements throughout their day — for example, walking sideways while carrying groceries from the car to the house, squatting instead of bending over to close a drawer. In other words they conducted their regular day to day routines but in a more careful way. At the end of one year, the LiFE group had  31% fewer falls than both other groups — a total of 172 falls, in comparison with 193 in the structured exercise group and 224 in the control group. People in general were  more likely to stick with the LiFE program than with either of the other two programs. A good way to incorporate balance exercises into your daily routine is to try standing on one leg while talking on the phone or sitting down in a chair without using your hands.

One of the uses of the LEGTUTOR and 3DTUTOR is intesnive exercises that are given by a physical therapist to improve balance. These and their sister devices (ARMTUTOR, HANDTUTOR) are part of a recently developed set of physical therapy products created to assist patients recovering from stroke, brain/spinal cord injuries, Parkinson’s, MS, CP and other upper or lower extremity limbs that became disabled. The TUTOR system consists of ergonomically designed gloves and braces placed on affected limbs and contain sensors to dedicated exercise software containing challenging games. The exercises are monitored by physical or occupational therapists who then design a customized exercise program for that patient.

 For the balance training individual the LEGTUTOR and 3DTUTOR are placed on one of the legs and the individual begins to play one of the games such as ”darts” while standing on only one leg. Then the device is placed on the second leg. In this way the leg muscles are strengthened and balance is maintained.

Currently in use in leading U.S. and European rehabilitation hospitals and clinics the TUTORs are fully certified by the FDA and CE. They are available for adults and children from the age of 5 and up and are functional at home through telerehabilitation.

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

 

Post Stroke Physical Therapy Exercise Products

Two-thirds of the 700,000 Americans who have a stroke each year survive and require rehabilitation. But fewer than one in three post-stroke patients undergoing physical therapy perform the at-home exercises their physical therapists recommend.

A team of researchers at Ohio State University is using a $653,000 grant from the Patient-Centered Outcomes Research Institute to develop a more fun and effective way for patients to work on regaining movement and mobility in their upper limbs.

Lynne Gauthier, an assistant professor of physical medicine and rehabilitation, is leading the team creating a video game for the Microsoft Kinect that the team hopes could expand access to a specific kind of rehabilitation called constraint-induced movement therapy. The game would allow patients with mild-to-moderate upper-limb impairment to perform guided CI therapy in their homes.

In standard stroke rehabilitation, patients only get a few hours of therapy each week and tend to develop what’s known as “nonuse,” in which they avoid use of the affected arm because it’s clumsy and awkward. CI therapy was designed to overcome nonuse by restraining the unaffected arm and upping the intensity of therapy to several hours a day over a period of two weeks.

Studies have demonstrated the ability of CI therapy to improve upper extremity function in patients shortly after stroke and after time has passed. Several studies have also shown changes in brain activity associated with the therapy.

Despite a body of research that suggests CI therapy is more effective than standard rehabilitation, it hasn’t become standard of care because it costs about $6,000 and isn’t typically covered by insurance, Gauthier said, so only a small number of specialty clinics offer it. Less than one percent of patients who are eligible for it are able to travel to those clinics and pay for it, she added.

Gauthier said her team’s objective is to develop and pilot a home-based program that retains the fundamental principles of CI therapy but changes the way it’s delivered, so more patients can access it for a lower cost ($500 or less). The video game the team is developing targets both subacute stroke patients who have completed inpatient rehabilitation as well as patients with chronic post-stroke impairment.

The game uses Microsoft Kinect’s motion capture technology to guide patients through a series of therapeutic exercises set in a river adventure theme, Gauthier said. Patients would visit a clinic for initial consultation and the game would act as a consultant to guide them through exercises at home. Patients would also be given a restraint mitt to encourage them to use their affected side more often in daily activities.

“A lot of these kinds of rehab games are basically about just getting the person to move a lot,” she said. “But we’re trying to make it so that the game would stimulate what the therapist would do. Just as a therapist would make a task harder when the person improves, the game would do the same thing.”

To do that, Gauthier is working with a cross-disciplinary team made up of a computer scientist, an electrical engineer, a biomechanist, two physical therapists and Gauthier, a psychologist and neuroscientist.

Eventually the team will create computer algorithms that would allow the program to track patients’ progress over time and provide performance feedback to patients and therapists. For the first year of the grant, though, it’s focused on game design.

Over the next several months, the team will work with patients and therapists to refine the game; the second year of the grant will focus on testing it in patients’ homes. “We feel it’s very important to involve stakeholders,” she said. “We don’t really know what the therapist response is going to be, but we are trying to involve them to make sure that we design a product that they would actually use.”

Kinect joins other physical therapy solutions already helping patients recover their lost mobility strengths. One such product is the TUTOR family of products. The HANDTUTOR, ARMTUTOR,LEGTUTOR and 3DTUTOR are ergonomically designed comfortable gloves and braces which are placed strategically on affected limbs and allows the patient to get intensive self initiated exercises via sensors that are connected to dedicated software.

The ARMTUTOR specifically trains the upper limb through dedicated software games such as : snowman, asteroid attack, car race and others. The exercises are designed to increase brain activity. Therapists monitor progress and then design a customized exercise program for that patient giving him appropriate feedback. The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are available through telerehabilitation in the patient’s home.

The TUTORs can be used by adults as well as children from the age of 5 and up and are fully certified by the FDA and CE.

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

 

Balance Exercises to Prevent Falls–A Harvard Medical School Report

A new book published by the Harvard School of Medicine discusses ways to cope with balance. 

Many falls result in disastrous injuries such as broken hips especially for the elderly. It affects independence and other general health problems not withstanding pain and discomfort. However 90% of falls can be prevented if proper exercises are used and precautions are taken.

Prominent amongst these efforts is learning how to maintain balance through strength, agility and mobility.

The book ”Better Balance” will alert you to conditions, medications, and situations that  create instability. There are  tips for fall-proofing your home.  ”Better Balance” will  lift, walk, stretch and  bend you through  workouts and exercises that will greatly increase your self-reliance, stability and confidence.

The report provides all you need to know about using exercise to improve posture, increase muscle strength and speed, sharpen reflexes, expand flexibility, and firm your core. Filled with workouts that respect your time and budget, ”Better Balance” gives you step-by-step instructions for achieving greater static and dynamic balance.

The report also includes complete, illustrated workouts that  can be done at home —according to your own schedule and pace.  These exercises were designed in consultation with Harvard Medical School physicians. They include guidance on proper techniques, tempo and movement. They modify workouts to your own level of fitness and exercise goals. The exercises  will keep you motivated and moving.

The goal in this book is to prevent you from having a potentially devastating fall and will  protect you from instability  allowing you to enjoy the independence and peace of mind that sound balance gives you.

Achieving good balance can also be achieved by a strict exercise program through well known physical therapy solutions and products such as the TUTOR system.

With the TUTOR system a LEGTUTOR and 3DTUTOR is placed on a leg. While  standing on one leg  a computerized game is played  created specifically for the TUTOR system. In this way the legs and lower limbs strengthen their muscles and balance coordination.

Originally designed for patients recovering from a variety of limb disabling diseases or surgeries i.e. stroke, brain or spinal cord injuries, CP, MS, Parkinson’s and others the TUTORs also include the HANDTUTOR and ARMTUTOR. Currently in use by leading U.S. and European rehabilitation hospitals and clinics they are fully certified by the FDA and CE.

The TUTORs can also be used at home through telerehabilitation and are available for children from the age of 5 as well as adults.

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

Comorbidity of ADHD and Motor Problems in Children–Some Solutions

Up to 50% of children with ADHD have motor problems which can have a severe impact on their daily lives. It seems that little attention is placed on this comorbidity issue and it goes untreated.

A study was conducted by interviews and questionnaire in The Netherlands with 235 children with ADHD and 108 controls showing that half of motor-affected children had received physiotherapy. Children that were treated had more severe motor problems but less frequently presented with comorbid anxiety and conduct disorder. Both groups (treated and untreated) were of the same general age, and rated similarly on ADHD testing scales and parental socio-economic status.

Apparently at the time of the survey undertreatment of motor problems in ADHD children occurs and behavioral factors play a role in referral and intervention.

Health workers should be aware of the impact of motor problems on the daily life of children with ADHD

 In clinical practice there seems to be less attention given to motor problems. Motor problems are usually not part of assessments for ADHD and are typically not included in intervention programs. A  child’s popularity and self-esteem is usually affected. Motor problems can cause difficulties in, for example, riding a bicycle, dressing, tying shoelaces or causing poor handwriting and sports abilities and can  further reduce children’s social participation and make them even more disadvantaged.

There are studies that have conclusively shown that physiotherapy of motor problems, especially child–centered, task-oriented approaches, can ameliorate motor disability and thus quality of life. Physical therapists  or occupational therapists can deliver interventions.  Parents and teachers can be instructed to manage motor problems as well, which may be helpful in case there are limited professional resources.

In the current study, the researchers examined if they could substantiate the clinical impression that motor problems don’t receive enough attention in the treatment of ADHD comorbid disorders. The main goal was to investigate in a well-diagnosed sample of children that had combined subtype ADHD, how many and which children were treated for motor problems. The investigation determined if treated and untreated children differed in age, gender, ADHD inattentive and hyperactive-impulsive symptoms scores, motor scores,  comorbidity with other conditions  such as: mood disorders, anxiety disorders,  conduct disorder, defiant disorder and socio-economic status of parents.This was done in order to predict actual treatment administration.

To detect  motor difficulties the Developmental Coordination Disorder Questionnaire  was completed by parents, and the Groningen Motor Observation scale was completed by teachers.

The parental socio-economic status was based on information concerning parents’ professions, gathered during the PACS interview. Professions were categorised into five levels, from manual labor to academic work.

A questionnaire concerning physical domains was designed for this study. This questionnaire was completed by parents and contained 36 questions about  motor milestones, sleep habits, development, infections, hospital admissions, medication and use of physiotherapy. The question that was evaluated in this study was : ‘Has your child ever been treated for motor problems by a physiotherapist?’

The study confirmed the impression that motor problems of children with ADHD are a neglected area of clinical attention. Roughly only half of the children with ADHD and motor problems in the study had received physiotherapy.

Apparently parents seek help earlier than teachers for children that are ADHD  This finding may point to a lack of communication on this subject between teacher and parents.

Physiotherapy or occupational therapy has been proven effective for treating motor problems.  Modern intervention methods are child-focused and help children  acquire important skills for daily activities, which can increase their quality of life.

When a child from the age of 5 and up develops motor problems due to ADHD there is a physical therapy solution that can be very helpful. Referred to as the TUTOR system it consists of a HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. Originally designed for patients that are recovering from a stroke, brain or spinal cord injury, CP, MS or many other upper or lower limb disabilities the TUTORs incorporate exclusive and challenging games into sensor-containing gloves and braces that allow the user to get intensive exercises. The ADHD child will actually enjoy using these devices at the same time that they are alleviating his motor problems.

Currently in use leading rehabilitation facilities around the world the TUTORs are fully certified by the FDA and CE.

For further information see WWW.MEDITOUCH.CO.IL

Step By Step Osteoarthritis Exercise Program

Always consult with your doctor before beginning an exercise program if you have osteoarthritis.

 

Stretching the Hamstring

 Walk for 5 minutes as a warmup.  Stretch. Lie down. Put a  bed sheet around your right foot and use it to help pull and stretch your leg up. Hold that position for 20 seconds. Repeat this twice, then switch legs. There are 3  important types of exercises for knee OA. Range of motion or stretching exercises which keep you limber. Strengthening exercises which build muscle strength in order to stabilize weak joints. Aerobic exercises, like walking, which help the lung and heart.

Stretching exercises help loosen muscles and improve flexibility. They also help prevent pain and injury.

While using a chair for balance, bend your right leg then step back with your left leg, slowly straightening it behind you. Press your left heel towards the floor. You will now feel the stretch in your back leg.

If you want more of a stretch then lean forward while bending the right knee deeper. However don’t let the right knee go past your toes. Hold this position for 20 seconds. Do it twice and then switch legs.

 Straight Leg Raise

 Lie on the floor and prop your back up on your elbows. Bend your left knee while keeping your foot on the floor. Keep the right leg straight with your toes pointed up. Tighten the thigh muscles of your right leg. Smoothly and slowly  use your thigh muscles — but not your back — to raise your leg.

Pause for five seconds. While your thigh is still tight, slowly lower your leg to the ground. Relax. Repeat this 10 times. Rest. Do another 10 sets; then switch legs.

Quad Set

If the straight leg raise is too tough then do quad sets instead. With these you don’t have to raise your leg. Just tighten the thigh muscles (quadriceps) of one leg at a time.

Begin by lying on the floor keeping both legs on the ground, relaxed. Flex and hold your left leg tense for five seconds and then  relax. Do 2 sets of 10. Then, switch to the other leg.

Seated Hip March

Doing this can strengthen hips and thigh muscles to help you with daily activities, like walking or getting up  from a chair.

Sit up straight in the chair.  Kick back your left foot but keep your toes on the floor. Lift your right foot off the floor while keeping your knee bent. Hold your right leg in the air for five seconds. Slowly lower your foot to the ground. Repeat this 10 times. Then rest and do another 10 after which you should  switch legs. If this is too hard use your hands to help raise your leg.

Pillow Squeeze

This will help strengthen the inside of your legs to give support to your knee. Lie on your back with both knees bent. Put a pillow between your knees.

Squeeze your knees together, squishing the pillow between them. Hold this for five seconds then relax. Repeat the set 10 times. Rest, then do another set of 10.

If this is too hard you can  do this exercise while seated.

Heel Raise

Hold the back of a chair for support. Stand straight and tall. Lift your heels off the ground and rise up on the toes of both feet. Hold it there for five seconds. Slowly lower both heels to the ground. Repeat this 10 times then rest and do another 10.

If this is too hard do the same exercise while sitting in a chair.

Side Leg Raise

Hold the back of a chair for balance. Place your body’s weight on your left leg. Lift the right leg outwards to the side. Keep your right leg straight. Keep your outer leg muscles tensed. Try not to slouch. Lower your right leg and relax. Repeat this 10 times. Rest. Do another 10 sets, then repeat  it with your left leg.

If this is too hard increase the leg height over time. Following a few workouts, you’ll be able to raise your leg higher.

Sit to Stand

Practice this move in order to make standing easier. Put two pillows on a chair. Sit on top of them, with your back straight and feet flat on the floor. While using your leg muscles, slowly and smoothly stand up tall. Then, slowly lower yourself back down to a sitting position. Make sure your bent knees don’t move in front  of your toes. Try this also with arms crossed  or loose to your side.

If this is too hard  add pillows or use a chair with armrests and then  help push up with your arms.

One Leg Balance

Try doing this hands-free or steady yourself on a chair, if necessary. Now, shift your body weight to one leg but don’t lock your knee straight. Then slowly raise the other foot off the ground, balancing on your standing leg. Hold that for 20 seconds then lower your  raised foot to the ground. Do this twice, then switch legs. This move helps you when getting out of cars or bending.

If you find this too easy, balance for a longer time. Or do it with your eyes closed.

Step Ups

This move can help you strengthen your legs for stair climbing. Face a stable step with both feet on the ground. First, step up with your left foot then follow with your right foot. Now, stand on top, tall and while both feet are flat. Climb down in the reverse order: Right foot down first, then left. Do this 10 times then rest and  repeat another 10 times. Now do it starting with your right leg first. If this is too  hard try using a railing, wall, a lower step or lamppost for balance.

Walking

If you have  stiff or sore knees you may not think that walking is a great idea but it actually is one of the best exercises for knee arthritis. Not only  can it reduce joint pain but it can also strengthen your leg muscles and improve flexibility. It’s also good for your heart and the best part is that there are no gym membership fees needed.

Having a good form is key: Look forward, keep your arms and legs moving, relaxed and walk tall.

Low-Impact Activities

Losing weight is a side benefit of being active and exercising. It also takes pressure off your joints. Other exercises that are easy on the knees are  swimming, biking and water aerobics. Water exercise can take weight off painful joints.

It isn’t necessary to give up your favorite activities, like golf. Discuss with  your doctor or physical therapist about modifying painful moves.

How Much Exercise?

Start with just a little. If there is no pain, do more next time. Try to aim for 30 minutes a day.

In the course of time you’ll build your leg muscles which will support your knee and increase flexibility.

It is normal to have some  muscle soreness  but hurting or swollen joints should have rest. Take a break and ask your doctor for advice. Ice painful joints and take ibuprofen, naproxen  or acetaminophen as a pain reliever.

Using physical therapy solutions and products is also an effective way to strengthen leg muscles which can alleviate osteoarthritis pain. The LEGTUTOR is one such device that can be used.

 The LEGTUTOR system is a key component of physical therapy used after total knee or hip  replacement and other knee and hip surgery. The LEGTUTOR is an ergonomic wearable leg brace with dedicated rehabilitation software.  The LEGTUTOR rehabilitation concept 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 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 is used by many leading rehabilitation 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.