What is Rehabilitation of a Spinal Cord Injury?

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

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

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

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

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

Physical Therapy Solutions of the Future

Many of us remember when, decades ago, we read in comic books  how Dick Tracy spoke on a ”wrist radio” to communicate with headquarters in pursuing a criminal. We were in awe when science fiction was portrayed in the same comics as travel between earth and celestial bodies or to and from man made space stations. Today almost everyone on earth possesses a cellphone to communicate with friends and family. Space travel today even has ”graduated” from an ”obsolete” system of shuttles to an international space station and one can read as ”history” about how man traveled to the moon and back. That’s how far man has come in this modern age.

Medicine has also moved rapidly through so many phases of improvement and innovation that today not only do people live longer but that under certain circumstances a patient may never meet his doctor or therapist on a face to face basis but rather through electronic systems. Surgery can be performed remotely and physical therapy can be administered through tele rehabilitation.

One of the newest physical therapy products being used extensively today is the HANDTUTOR. It and its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) are at the forefront of physical therapy solutions that allow patients suffering from Parkinson’s disease, CP, MS, stroke, brain and spinal cord injury as well as upper and lower limb surgeries to receive state of the art assistance in recovering use of a disabled limb. This is done through the use of customized ergonomic
gloves and braces that are connected to exclusive software where the patient is involved in intensive exercises through the use of challenging games. The results are channeled to a physical/occupational therapist who records them and creates a customized therapy program for the patient. This is especially helpful to the patient who has recovered sufficiently to be discharged from acute care and/or for those patients who cannot afford or live too far from a professional physical therapy facility. The TUTOR system is one of the most cost effective physical therapy products on the market today and is fully certified by the FDA and CE. Go to WWW.MEDITOUCH.CO.IL for more information.

The ”Game” of Physical Therapy Solutions

A study by  Marlene Sandlund etal published in Disability and Rehabilitation, April 2012 discusses parents’ perceptions of using low-cost motion interactive video games as a physical therapy solution in home training for their children who have cerebral palsy.  The parents’ perception of the ”game” training was very positive. They expressed the view that motion interactive video games may promote positive experiences of physical training in rehabilitation, because the social aspects of gaming were  valued. Further, the parents experienced less need to take on coaching while gaming stimulated independent training. However, they expressed  a desire for more controlled and individualized games in order to better challenge the specific rehabilitative need of each child. The conclusions reached were that low-cost motion interactive games may provide increased motivation and social interaction over home training and also promote independent training with reduced coaching efforts for the parents. They felt that in future designs of interactive games for rehabilitation purposes, it is important to preserve the motivational and social features of games while optimizing the individualized physical exercise.

Children with neurodevelopmental disorders like cerebral palsy (CP) are in need of fun and engaging rehabilitation methods to enhance motivation and increase compliance with motor training.There is a rising interest among clinical professionals and parents to use motion interactive games as a rehabilitation device for these children. In this qualitative study parents perceived that motion interactive games can enhance motivation for practice, stimulate the child and reduce the parental efforts related to home-based rehabilitation of children with CP.

While all of the above statements are true it would be much more efficient and worthwhile if the interactive games were designed exclusively for CP patients and monitored by professional therapists who specialize in these specific physical therapy solutions. Such is the function of the TUTOR system. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR have been around now for several years assisting parents with CP as well as MS, stroke, spinal cord/brain injury and other upper and lower limb injuries/surgeries. The TUTORs are among the most cost efficient physical therapy tools created for these types of rehabilitation.

The methods incorporated in these physical therapy products is a series of challenging games that were specifically formulated to rehabilitate such patients. Games like ”snowball”, ”car race”, ”bubbles”, ”track a target”, ”asteroid attack”, ”sky defender” and more give the child patient (as well as the adult patient) a series of fun games to rehabilitate their affected limbs by allowing for customized controlled and intensive exercise practice. Children as young as 4 or 5 years of age can avail themselves of these exercises. Through the use of telerehabilitation the patients can connect to professional therapists at the other end of the internet connection. See WWW.MEDITOUCH.CO.IL for more information.

Who Stimulates Physical Therapy?

In a race to produce the newest device allowing limb movement mobility following stroke or other paralyzing diseases or injuries, companies are producing a myriad of robotic instruments aimed to ”assist” the patient to move his affected limb.

As an example, a German engineering firm has recently developed a mechanical exo-skeleton that can be worn like a glove to increase productivity for factory workers or help in the rehabilitation of stroke patients.

The device uses pneumatic actuators on each finger to simulate the range of human finger movement. The ”actuators move the fingers” so that they can be opened and closed.

The disadvantage with such devices are that they are large and cumbersome, are very expensive to use, can only be used where the device exists and, as above, does the work for the patient instead of having the patient learn the movement on his own.

The HANDTUTOR, on the other hand, is  a small, easy to put on ergonomic glove-like device that fits snugly onto the patient’s hand, allows quite a bit of room to maneuver, is one of the most cost effective medical devices of its type and can be used in the clinic, hospital or even at home through the use of telerehabilitation. Most important, though, is the fact that the patient himself activates the movement and thereby relearns his original skill rather than depending on an outside source to stimulate the limb.

The HANDTUTOR and its sister physical therapy products (ARMTUTOR, LEGTUTOR, 3DTUTOR) challenges the patient to intensive active exercises through the use of special rehabilitation games. The results are monitored by physical or occupational therapists who then evaluate the patient’s progress and customize a program appropriate for that patient’s ability.

The TUTORs are physical therapy solutions that are currently in use in leading U.S. and European hospitals and clinics and are fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for more information.

Pediatric Neurology Solutions

The following is a summary of a study published in
the European Journal of Paediatric Neurology( EJPN) in  January,2012. The official journal of the European Paediatric Neurology Society .

 It is important to gain insights into upper limb impairments and how they relate with activity  in children who have unilateral cerebral palsy (CP). It is also important  to optimize treatment interventions. The  AIMS of the study were (1) To investigate upper limb impairments and activity limitations in children with unilateral CP; (2) to compare these impairments according to the Manual Ability Classification System (MACS) and (3) to determine the impact of impairments on activity measures.

 Eighty-one children with unilateral CP aged 5-15 years were used in the study. The  CONCLUSIONS reached in general were that additional use of impairment-based interventions were necessary.

Enter the TUTORs. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. are newly developed physical therapy products that have become a key system in

neuromuscular rehabilitation that provides additional impairment interventions. The TUTORs are used for victims of CP,

stroke, brain and spinal injuries, Parkinson’s, MS and other limb movement limitations. These innovative products implement an impairment based program with augmented motion feedback that encourages motor learning through intensive active exercises and movement practice. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR 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  games to set a new target for this movement in terms of the patient’s ability to move their limb. The devices then measure that movement and give feedback on the success of the patient in trying to gain his objective. In this  way the patient is given  feedback that lets him understand which effort is more successful in allowing  their affected limb to gain normal movement.  The TUTOR system are physical therapy products that provide exercises that are challenging and motivating and allow for repetitive and intensive exercise practice.

The TUTORs are now part of the physical therapy solutions of leading U.S. German, Italian, French, UK and other foreign hospitals. See WWW.MEDITOUCH.CO.IL for more information.

Benefits of Yoga and Physical Therapy Solutions

Following the birth of a  child and the accompanying aches and pains it is advisable to begin exercising and return to previous fitness levels. Enrolling in a Yoga class, running and biking would be a preferred routine. Yoga can make the participant feel better and better the more it’s done. Yoga and physical therapy improve function and decrease pain for a variety of reasons. The two concurrent programs can target individual specific needs such as flexibility, strength and posture. Yoga may be the originator of many physical therapy exercises. The yoga specialists and physical therapists are specialists in musculoskeletal deficiencies as well as some diseases. The mind/body connection is very important to the success of both skills. Both systems manage injury and disease by incorporating powerful mindfulness and movement. Post-partum pain and  chronic low back pain can be helped by both.

The patient of Parkinson’s, spinal cord/brain injury, MS, CP, upper and lower limb surgeries amongst other disabling diseases can benefit from a combination of Yoga and physical therapy solutions such as the TUTOR system.

 The newly developed HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR and 3DTUTOR) have become a key system in neuromuscular rehabilitation for stroke victims and those recovering from brain and spinal injuries,Parkinson’s, MS, 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 HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR consist of 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 affected 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 getting them to move their affected limb again. In this  way the Tutor system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3 DTUTOR are physical therapy products that are 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.

Balance Therapy as a Physical Therapy Solution

OAKLAND, Calif., Apr 25, 2012.

Attaining proper balance and walking ability for Multiple Sclerosis patients is a challenge, An NIH study entitled “Movement Ability Changes with Balance-Based Torso-Weighting (BBTW) in Multiple Sclerosis”  provided important results for Multiple Sclerosis (MS) patients suffering with balance and walking challenges. The study was funded by a National Institutes of Health Recovery Grant at Samuel Merritt University (SMU). Physical Therapy Professor Dr. Gail Widener, PT, and Dr. Diane Allen at San Francisco State University could thereby  continue to do research into Balance-Based Torso Weighting (BBTW) and its effects on Multiple Sclerosis mobility challenges.

The first phase of the study establishes that previous research funded by the National MS Society is validated. Physical Therapist, Cynthia Gibson-Horn, discovered that strategic application of small amounts of weight could counter-balance directional losses and dramatically improve stability in  patients with MS, Parkinson’s disease, stroke, TBI, ataxia and other Sensory Based Motor Disorders (SBMD) while receiving treatment. This discovery led to the development of the  BBTW method, which has  helped hundreds of patients.

“The first phase of the NIH study supplements other research into BBTW, the technology behind BalanceWear, which has been highly successful in improving mobility for patients with MS,” according to Steve Cookston, of Motion Therapeutics. Gibson-Horn agrees that each case is different regarding the degree of improvement that can be achieved after being  fitted with BalanceWear. “Some patients walk nearly normally with BalanceWear” she says. “We can see immediately upon application if a patient’s balance has been corrected. Further, we now know that the improved stability provided by BalanceWear improves confidence, which can lead to improved success in physical therapy which often accelerates results.” Balance-Based Torso-Weighting is an assessment and treatment method that results in a BalanceWear custom made, strategically weighted orthotic. BalanceWear is made to the exact specifications for the patient’s counter-balancing requirements. It provides supplementary sensory information to the nervous system, and helps to improve balance and stability in all directions of movement. Clinically, patients with Parkinson’s disease, Multiple Sclerosis, stroke, head trauma, brain surgery, osteoporosis, ataxia, Cerebral Palsy and dizziness  have found balance and mobility improvement with BalanceWear.

Balance therapy is also one of the functions of the TUTOR system. Basically a LEGTUTOR or 3DTUTOR is placed on the less impaired leg and/or the more impaired leg.The patient then  stands on one leg (either impaired or healthy)  and then plays an aiming game like ”darts”. In this way he strengthens both his legs and improves balance as well as cognition.It also improves confidence and stability.

 The TUTOR system, consisting of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR,  has been developed to allow for functional rehabilitation of the whole body including the upper and lower extremity. The TUTORS are physical therapy products that consist of ergonomic wearable braces and include dedicated rehabilitation software that provide patient instructions and feedback to encourage intensive controlled exercise practice. The HANDTUTOR is used to give hand therapy to patients with SCI, Parkinson’s disease, CP, MS, stroke, Radial/Ulnar nerve and Brachial Plexus injuries. Hand, arm and leg surgery rehabilitation are also assisted by the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. The TUTOR system allows for controlled exercise of multijoints within the normal movement pattern which prevents the development of undesired and compensatory joint movement. This is especially important to ensure that brain and spinal cord injury patients learn to better perform functional tasks.

 The  TUTOR system is a physical therapy solution for manual therapy. Medical, physical and occupational therapists use the tool for children as well as adults and can also practice tele rehabilitation using the Tutors. They are FDA and CE certified. See WWW.MEDITOUCH.CO.IL for more information., .

Post Knee Replacement Physical Therapy–A “Piece of Cake”?

There are probably more articles about knee replacement than about any other medical  procedure. One can read about expert advice and situations on a daily basis. And why not? There are approximately 600,000 knee replacements annually just in the U.S. alone. What is crucial, though, is the aftercare. If the surgery is to be successful the follow up therapy and advice needs to be adhered to. At first walkers and crutches are used, sitting in a chair for up to half an hour and then isometric exercises. All this before physical therapy even begins at home or elsewhere. One of the most important exercises will be to push the knee down in extension.

When the therapy begins  one of the best physical therapy solutions that can be helpful is the LEGTUTOR.

The LEGTUTOR has shown remarkable success in post knee replacement surgery. The LEGTUTOR™ system has been developed to allow for functional rehabilitation of the lower extremity. Together with the 3DTUTOR the LEGTUTOR can be used to increase the patient’s proprioception performance with dedicated games  developed in the rehabilitation software for this outcome. The TUTOR system rehabilitation concept, which includes the HANDTUTOR, ARMTUTOR and 3DTUTOR, is based on performing controlled exercise rehabilitation practice at a patient customized level including balance and proprioception training. This is achieved with real time accurate feedback on the patient’s performance.  The exercises are designed in the form of challenging rehabilitation games that are suitable for a wide variety of neurological and orthopedic injury and disease. The games challenge the patient to perform the exercise task to their best ability and to continue exercise practice. Exercise practice is the most important manual therapy tool in the armory of physical and occupational therapists to ensure optimal rehabilitation.

The LEGTUTOR™ is a physical therapy product that allows for isolated and a combination of knee and three directional hip treatment. The system provides detailed exercise performance instructions and precise feedback on the patient’s exercise performance. Controlled exercise of multi joints within the normal movement pattern prevents the development of undesired and compensatory joint movement and ensures better performance of functional tasks.

 The LEGTUTOR™ system is a physical therapy solution used by many leading rehabilitation centers worldwide for both neurological and orthopedic patients including adults and children. The TUTOR system holds FDA and CE certification. See WWW.MEDITOUCH.CO.IL for more information.

Mental Imagery as a Tool in Physical Therapy

Drs. M. Grangeon, P. Revol, A. Guillot, G. Rode and C. Collet of  The Physical Medicine and Rehabilitation Unit at the Henry Gabrielle Hospital in Lyon, France conducted a study to see whether motor imagery could be used along with conventional therapy for patients with spinal cord injury relevant to upper limb functioning.

 

A participant was used where MI content was focused on  improving hand transport to reach out and grasp with tenodesis. The participant was tested before and after 15  training sessions that lasted 45 min each, three times a week for 5  weeks.

 

  The participant’s ability to generate MI was checked and compliance with the rehabilitation program was confirmed.  Decreased movement time and enhanced hand trajectory smoothness were still observed 3 months later, despite a slight decrease in performance.

 

This study therefore supported the feasibility for introducing MI in conventional therapy. Further studies should confirm the potential role of MI in motor recovery with a larger sample.

 

Upper limb functioning relevant to spinal cord injury is also treated with the newly innovated TUTOR system. Specifically the ARMTUTOR has the capability to enhance the intensive exercise programs necessary to restore normal functioning to those affected.

 

 

The ARMTUTOR system, as a physical therapy product, has been developed to allow for functional rehabilitation of the shoulder, elbow, wrist or upper extremity. The system consists of an ergonomic wearable arm brace and dedicated physical rehabilitation software. The ARMTUTOR system allows for interactive rehabilitation exercise and  a range of biomechanical evaluations including speed, passive and active range of motion and motion analysis of the upper extremity. This quantitative data allows physical and occupational therapists (PT) (OT) to customize the right exercise parameters to the patient’s movement ability and report on the patient’s exercise progress. The ARMTUTOR rehabilitation concept is based on performing controlled and repetitive exercise rehabilitation practice. It does this through the use of various games which are at a patient-customized level with real time accurate feedback on the patient’s performance.  The rehabilitation games are suitable for a wide variety of neurological and orthopedic injuries and diseases.

 

The games challenge the patient to perform the exercise at a customized difficulty level. This level is set by the Physiotehrapist, OT or PT and encourages the patient to do intensive repetitive exercise practice.

 

The ARMTUTOR allows for isolated and a combination of elbow and three directional shoulder treatments. The physical therapy solution that also includes the HANDTUTOR, LEGTUTOR and 3DTUTOR, provides detailed exercise performance instructions and precise feedback on the patient’s exercise performance. Overall, controlled exercise of multijoints within a normal movement pattern will prevent the patient developing an undesired or compensatory joint movement pattern and this will ensure better performance of functional tasks.

 

The ARMTUTOR and its sister devices  are among the foremost physical rehabilitation tools and are used wordwide in hospitals and clinics. They can be used at home through telerehabilitation See WWW.MEDITOUCH.CO.IL for more information.

 

 

 

 

Internet Based Versus Conventional Physical Therapy

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

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

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