Controlled exercise practice following stroke

eccentric resistance training

Writing in Neurorehabil Neural Repair  Jan 2013 Dr. Clark from Randall VA Medical Center, Gainesville, FL, USA shows that eccentric (ECC) resistance training is more effective than concentric (CNN) resistance training in improving walking speed following stroke.

It is worth considering further controlling exercise practice in terms of speed and range of motion using the LegTutor so that intensive controlled exercise practice will further concentrate on eccentric resistance training together with motion feedback.

Paralysis From a Non-Physical Source?

Arriving at the University Medical Center in Salt Lake City all the way from South Africa, the helicopter carrying Jeremy Clark landed noisily. Jeremy, a 23 year old college graduate had been on a Mormon religious mission for just a few weeks when he woke one morning to find that his legs were completely paralyzed. Doctors in S.A. were unable to find anything wrong with him medically.

Also not speaking made his examination process in Utah more difficult. Doctors were determined to get to the bottom of the problem and arranged for various tests to be performed. It was necessary to rule out diseases such as multiple sclerosis (ms); myasthenia gravis, a neuromuscular autoimmune disease that causes varying degrees of muscle weakness; Guillain-Barré syndrome, an acute condition associated with progressive muscle weakness and paralysis and stroke. A lumbar puncture to collect fluid from around the brain and inside the spinal cord had to be done to rule out infection.  

Then a full medical examination was conducted. Jeremy was a healthy and physically fit young man and his heart, lungs, abdomen, neurological exam, muscle tone all acted in a normal fashion. He was able to move his head, neck and arms without a problem but his legs would not move at all. More surprising was the fact that tapping his legs with a rubber hammer showed that there was no damage to the nerve path between muscles and spinal cord.

A stroke was ruled out as that usually would have affected only one side of the body. A discussion with Jeremy’s parents ruled out drug use or mental health problems. A doctor involved in the case was wondering whether Jeremy was ”faking” his symptoms and finally the staff psychiatrist was called in for an evaluation.

After another neurological exam the psychiatrist came up with a diagnosis of ”conversion disorder”. He explained that conversion disorder is an unusual psychological state with symptoms that resemble a neurological disorder or another medical condition. It usually begins abruptly and begins with a mental conflict or emotional crisis. Then it “converts” to a physical problem that prevents the patient from being involved in the activity that was causing him stress. There are a relatively small number of cases reported per 100,000 people and it is more common in women. Beginning at almost any age it usually occurs between the ages of 11 and 35. Aside from paralysis it can also cause amnesia, blindness, motor tics and other ”symptoms”.Usually the disorder will disappear spontaneously after 2 weeks of hospitalization and in some cases a physical illness is discovered later.

Jeremy was told about his condition, reassured that there was no physical disability and that he would recover very soon. After further routine questioning Jeremy broke down and and stated that he could not continue with the mission he was sent on. He didn’t like talking about religion with people. He was reluctant to come home because he thought he would let his parents or God down . This caused him enormous stress. The doctor informed him that no one could force him to go back. The situation was explained to his parents who agreed to get involved in his therapy sessions and rehabilitation. Within days Jeremy was walking the halls and was discharged from the hospital after making a complete recovery from the paralysis.

When a disease or surgery causes an incomplete paralysis of a limb or joint the most effective physical therapy solution should be found. Fortunately, a recent innovation has created the TUTOR system of products known as the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. The TUTOR system was developed to allow intensive exercise practice to those who have incurred a stroke, brain/spinal cord injury, MS, CP, knee/hip surgery or other type of upper or lower limb disabling event.

The TUTORs consist of ergonomically comfortable gloves or braces that are strategically placed and contain sensors connected to sophisticated exercise game programs. Physical or occupational therapists record and monitor the progress made and then design a specific exercise regimen for that patient. The TUTOR system is now in use in leading U.S. and European hospitals and clinics. Fully certified by the FDA and CE they are available for use at home through telerehabilitation and can be used by adults and children from the age of 5 and up. See WWW.MEDITOUCH.CO.IL for further information.

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.

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.

Trunk Restraint and the TUTOR As Tools for Reach and Grasp

Since the goal in physical rehabilitation is to return the patient‘s functional ability to as near as possible to the pre event state it is necessary for the patient to become as independent as possible and  to relearn basic skills like eating, dressing, walking and grasping. This will preserve the patient’s dignity and reduce the burden on family.

A study was performed by Stella M. Michaelsen, PhD etal from the School of Rehabilitation, University of Montreal and the Centre for Interdisciplinary Research in Rehabilitation, Rehabilitation Institute of Montreal, Quebec, Canada. The Purpose of the study was to discover the advantages of trunk movement restriction when attempting to reach an item placed within arm’s reach by patients with hemiparesis caused by stroke. Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term. Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination. To evaluate the potential of this technique as a therapeutic intervention, a comparison was made as to the effects of short-term reach-to-grasp training with a 60 session trial with and without physical trunk restraint on arm movement.

 A total of 28 patients with hemiparesis were divided into 2 groups: One group practiced reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness as a trunk restraint, and the second group practiced the identical task but they were verbally instructed not to move the trunk (control group). Before, immediately after and 24 hours after training, Kinematics of reaching and grasping an object placed within arm’s length were recorded.

 The results showed that the trunk restraint group used more elbow extension, less anterior trunk displacement and had better interjoint coordination than the control group after training. In addition range of motion was maintained 24 hours later in only the trunk restraint group.

Therefore it was concluded that restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements by chronic stroke patients than practice alone.

Also, in order to train grasp through hand therapy, the occupational and physical therapists have to improve both the patient’s finger range of motion and movement. This means that the OT and PT have to work on the patient’s motor movement in terms of strength, accuracy and balance of antagonistic muscle movements as well as pattern of joint movements.

In addition to hand therapy the OT and PT will have to work on the patient’s shoulder, elbow and wrist movement ability as these joints are also used during a reach, grab and grasp task.

Proper exercise practice using the TUTOR system will allow the patient to implement the correct pattern of multijoint movements in order to perform the functional grasp task. Therefore the OT and the PT will use the ARMTUTOR for shoulder and elbow intensive exercise practice and the HANDTUTOR for wrist and finger movement practice.

The dedicated rehabilitation software of the TUTOR system allows the occupational and physical therapists to  work on the correct pattern of joint movement with feedback from the shoulder and the elbow. Together with the accompanying motion feedback from the HANDTUTOR the patient will learn how to perform the grasp task through repetitive exercise practice.

The TUTOR system is used extensively in rehabilitation hospitals and clinics in the U.S.and Europe and are fully certified by the FDA and CE.

Telerehabilitation allows the patient to continue his exercise program at home or if he is located too far from a rehabilitation facility.

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

 

Getting Workers Back To the Workplace After Upper Extremity Injuries

There have been many more work related upper extremity injuries and pain  in the last number of years compared to the previous years especially when the employee returns to the workplace after an injury.

There are many reasons that this occurs. Amongst them are physical capabilities, risks of the job, psychological readiness to continue working, worker traits and the ability to manage their symptoms.

It is suggested that  there be a comprehensive program which targets these factors so as to minimize the problem.

A study was conducted using two groups of people that had common traits i.e. physical conditioning, work related pain and stress management issues, work conditioning and vocational counseling or placement. The purpose of the study was to  investigate the long term outcome of a rehabilitation program. Both groups had equal measures of disability, fear of being injured again, severity of pain, psychological distress, age and education. The groups were exposed to either the comprehensive work rehabilitation intervention or just usual care. Their status was evaluated about 17 months after treatment for the study group and 18 months for the control group.

The results were that more of the study group members (74%) returned to work or were getting vocational training versus 40% of those in the control group. In addition 91% of the study group returned to full time work versus 50% of the control group. The reentry rate was not, however, as high as other approaches with low back pain employees. This suggests that the treatment program needs some modification. Perhaps  there should be a remedy found for reducing repetitiveness, awkward posture, force, rest cycles and other stress related aspects of the job.

Another suggestion is to find ways to improve flexibility and strength of the upper extremities and ways to reduce pain and stress. Such training may contribute to a more successful rate of return to work.

A physical therapy solution could also be used to strengthen upper extremity limbs. One such product is the ARMTUTOR. Originally developed to provide intensive exercise s to patients suffering from Parkinson’s disease symptoms, spinal cord injuries, Cerebral Palsy and other limb disabling illnesses, the ARMTUTOR can also be used as a preventative device to strengthen upper limb muscles so that workers will gain more ability to conduct their duties.

The ARMTUTOR consists of a safe comfortable elbow brace with position and speed sensors that precisely record three dimensional shoulder and elbow movements. The ARMTUTOR has a range of motion limiter that limits the dynamic range of elbow extension and flexion and facilitates treatment of the upper extremity including isolated and combined shoulder and elbow movements.

The ARMTUTOR and its sister products (HANDTUTOR, LEGTUTOR and 3DTUTOR) are currently in use in leading U.S. and European hospitals and rehabilitation clinics. They are also available for use in the home through telerehabilitation and are certified by the FDA and CE..

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

What to do About Shin Splints?

new frisbee wrap (Photo credit: Phil Denton)

 

A common problem for runners is Shin Splints. Overtraining and improper footwear may cause this injury. Runners finding themselves with Shin Splints should R.I.C.E.(rest, ice, compression and elevation) to reduce the symptoms. They should also seek the help of a physical therapist to address any biomechanical causes of their symptoms. Furthermore they should  have their shoes checked to determine if there is excessive wear and if the shoes fit properly. If  muscle balance is maintained and  mileage is built up gradually that generally allows most runners to resume running without symptoms.

What exactly are Shin Splints?

 “Shin Splints” is a  term that describes a pain in the lower part of the leg associated with running and other athletic activities. Pain may be felt in the  back (posterior) or in the front (anterior)of the lower leg. Anterior Shin Splints are more frequent than posterior. The pain  is due to tiny tears in the muscles where they are attached to the shin. Pain occurs  with activity and usually subsides with rest. It is common for beginner runners to suffer from Shin  Splints but can affect  all levels of ability and experience.

What can be done about Shin Splints?

The first remedy that a runner can do if he develops Shin Splints is to stop running for a few days to rest his leg(s). Running exercises are generally acceptable unless there is pain. These is true as well for  swimming, pool- running, biking, or using an elliptical trainer. Anti-inflammatory medication and ice treatment are also helpful. Another cause for Shin Splints can be muscle imbalances  so it is advisable to get an  evaluation and treatment by a physical therapist to check out musculoskeletal issues. The physical therapist or physician may also use massage, ultrasound, iontophoresis, or other treatment modalities to alleviate acute symptoms.

Overtraining is also a cause of Shin Splints.  Running too many miles without enough rest days in between or if too much mileage is accumulated in one week  may be also be contributing to pain symptoms.

Another factor to consider is whether the shoes used have more than 300-500 miles on them. If so, it may be time to change shoes. Alternatively, the shoes may be  new and that’s where the problem lies. Shoes should allow the right amount of motion control for pronation and should have good shock absorption. Be sure the shoes you are wearing are the correct ones for your foot.

With treatment, shin splints will disappear within a few weeks. However, if your pain persists, it is possible that there is a fracture and a doctor should be consulted.

How Do I Prevent Shin Splints From Coming Back?

1) Resume running but slowly and with a slow build up.

2) Run on softer surfaces if possible.

3) Take rest days and incorporate cross-training activities.

Running and other sports  including basketball, football, soccer, skiing, and gymnastics put high demand on the knee and may lead to knee damage such as ACL tears. The state of the art physical therapy solution, LEGTUTOR, was originally designed to treat lower limb injuries and knee and hip replacement surgery however it is also used to strengthen knee muscles prior knee surgery. The LEGTUTOR is a comfortable ergonomically designed  brace that is  strategically placed and contains speed sensors that record three dimensional movements. They are connected to a computerized set of exclusive rehabilitation games  that allow the patient to exercise range of motion, speed and accuracy of movement. Physical/Occupational therapists monitor the progress made by the patient and subsequently create a customized exercise program for him. The LEGTUTOR and its sister devices (HANDTUTOR, ARMTUTOR and 3DTUTOR) also treat patients who ave suffered from a stroke, brain/spinal cord injury, Parkinson’s, MS, CP and other upper and lower limb injuries or surgeries.

Currently in use in leading U.S. and European hospitals and clinics the TUTOR system can be used by adults and children from the age of 5 and up. Fully certified by the FDA and CE the TUTORs are also available for use in the patient’s home through telerehabilitation.

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

How Do Gross and Fine Motor Learning Development Traits Develop?

 

During the first 5 years of life, body structure growth is  rapid and even amazing. Boys will grow from approximately 20 inches to 34 inches and from 7.5 lbs to 28 lbs during the first 2 years of their life.  Following that, on average, they gain about 2 inches  and between 4 and 6 lbs. annually until they reach puberty.  Girls grow at a  slower rate but on the same curve.

Muscle and bone growth  depend on the growth curve of weight. Bones are formed in the fetus with soft cartilage. They begin to harden from the midportion of bone,and continue hardening at the end of long bones after birth. Muscle weight also increases at a rapid pace  during the early years. This growth is caused by the  increase in the  breadth and length of the muscle fiber.

The nervous system, including the spinal cord, brain, and nerves, control all the body’s movement.  Early reflexes are controlled by the midbrain.  Then the cerebral cortex controls voluntary motor movements and its purpose. The cerebellum controls and coordinates balance, timing,  and involuntary motor acts (e.g. breathing and heartbeat).

Genes are the primary determiners of potential growth although there are other factors as well, such as absence of severe illness in utero and early in life, mother’s diet and positive environmental facts. They all will support appropriate development and growth.

All motor skill development are reflexes that begin development in the uterus. Many reflexes, such as the startle reflex and the rooting reflex  are present at birth. As the infant matures,  these reflexes are inhibited, and movements become differentiated so that voluntary responses are performed.

There is a second set of gross motor skills to develop which includes the upright-positioning skills.  This leads the person  to develop a vertical position, which becomes necessary for locomotion.   Exploration and learning  as well as socialization, are dependent on the  child’s ability to move about the environment. The infant  learns to lift the head, which allows him to turn from front to back. Then as trunk control increases, the child is able to sit up. From there a series of movements develop whereby the child can begin turning his legs outward at the hips, then bending the legs at the knees  and finally placing hands on the floor,  allowing for crawling to begin.

After the  crawling stage between 9 and 12 months, a child learns to pull up with objects or with the help of adults and is able to stand. Crawling doesn’t allow for manipulating objects so this is an important milestone. After the walking stage  other forms of locomotion, such as climbing, running and jumping occur within 2 to 2 ½ years.

When infants are born they have a grasp reflex. They close their hands around anything placed there even though they don’t yet know how to release the grasp. At a later stage  manipulating, reaching, grasping  and releasing skills appear.  Known as ”prehensile skills” an infant spends time discovering his hands and just watching them move. This latter stage is very important as it allows the child to learn eye-hand coordination and early learning.

The sequence of development comes in several stages. Thus, infants gain control of their shoulders before they gain control of their arms.  They can reach before they can grasp. After controlling arm movement, the child proceeds to  use his hands and finally, fingers.

There is a sequence as well for the hand finger motions. When the child grasps at first  it is achieved by having the fist in a downward position.  To learn to move it to an upward position is quite a task. We often take for granted the complicated task of eating skills. The child has a pronated (downward) position with his fist. Then he has to turn the wrist and place the food into his mouth.  Usually this is accomplished by the time the child has reached 13 months. Later there is the  ”pincer grasp”, by which an object is held between the index finger and thumb. This pincer grasp is needed in order  to hold writing implements because that requires what is called ”the tripod grasp”, which is the pincer along with the balance and support provided by the middle finger.  Some children will have difficulty achieving the higher level grasps. Because of that   fine motor skills are taught in preschool, which helps to increase fine motor strength,  coordination flexibility and smoothness of motion.

When children play, motor activities need to be included because they need these skills and accomplish even more complex ones that they will need later in life. Other aspects of motor development include: increasing flexibility in joints so as to increase range of motion,  continued strengthening, reaction time, agility,  coordination, balance,  and speed.  These are all needed to develop a fit and well rounded individual.

If reaching, grasping, releasing and manipulating skills are impaired due to pre or post birth neurological problems or disease then devices such as the HANDTUTOR can be incorporated into a physical therapy solution. The HANDTUTOR can also assist in developing  fine motor skills impairment. The TUTOR system which also includes the ARMTUTOR, LEGTUTOR and 3DTUTOR, can be used in children from the age of 5 and over. The TUTORs are gloves or braces that are ergonomically designed and with sensors allow the patient to do intensive computer exercises with dedicated, challenging and enjoyable games. Physical and occupational therapists monitor and record the progress made by the patient and then design a customized program for him. The TUTORs were also designed to increase limb movement for those who had a stroke, Parkinson’s disease, brain or spinal cord injury and other upper and lower limb disabilities or surgeries.

Currently in use in leading rehabilitation hospitals and clinics in the U.S. and Europe, the TUTOR system can also be used in the patient’s home through telerehabilitation. The TUTORs are fully certified by the FDA and CE.

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

Post Stroke Rehabilitation–An Important Review

 More than 700,000 people suffer a stroke each year in the United States.  Approximately two-thirds of these individuals survive but require rehabilitation.  Rehabilitation goals are to get survivors to become as independent as possible and to achieve the best possible quality of life. Rehabilitation cannot reverse what was done but it can achieve the best possible outcome.

Stroke patients usually lose movement ability in their limbs due to brain damage. Physical rehabilitation is the method used to try to relearn those lost skills. An example would be  coordinating leg movements in order to walk or any other complex activity. Rehabilitation can also teach survivors new ways of performing tasks in order to circumvent or compensate for any residual disabilities. Another example would be that individuals may need to relearn  to bathe and dress by using only one hand, or  to communicate efficiently when their  language usage has been compromised.  Experts agree that the most effective part of rehabilitation is that it is carefully directed, focused and contains repetitive practice similar to what everyone needs to do in order to learn a new skill.

Physical rehabilitation for stroke   begins in the acute-care hospital after stabilization has occurred which is usually after   24 to 48 hours following the event. Patients are urged to begin independent movement because they suffer from some paralysis or are weakened. They are urged to change bed positions frequently while lying down and also to engage in range of motion activities that are both passive and active. This is done in order to strengthen their impaired limbs. “Passive”  exercises are those  where the therapist  helps the patient move a limb repeatedly and “active” exercises are those performed by the patient himself–not through robotic devices. A successful progression would be for the patient to sit up, move from bed to chair, stand and then walk with or without assistance. Further progress would be made if the patient can bathe, dress and use a toilet on their own.  Reacquiring the ability to carry out these  activities of daily living would be the first stage in a stroke survivor’s return to independence.

Some stroke survivors  will have to work with specialists for months or years to maintain and sharpen these skills.

Using the most effective physical therapy products can hasten the progress to independence. An example of this is the HANDTUTOR and LEGTUTOR. Created to assist the stroke patient with intensive exercise practice the TUTOR system (which includes the ARMTUTOR and 3DTUTOR) consists of devices that encourage self motivating and repetitive exercises for range of motion and other limb movements. The dedicated software includes challenging games that allow the patient to achieve success. The physical and occupational therapist record and monitor the progress made and customize a program for that specific patient.

Currently in use by leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE. In addition they can be used at the patient’s home through telerehabilitation. See WWW.MEDITOUCH.CO.IL for more information.

Exercises Following Shoulder Surgery

 

 

It is important to have a regular exercise routine following shoulder (or arm) surgery. These will restore normal motion and flexibility and allow a return to work and normal activities. A physical therapist or orthopedic surgeon will probably recommend an exercise program consisting of 15 minutes several times per day.

 Here are some of the routines that can be followed: (For particular details on the specific exercise search for it by name or speak to your professional). Pendulum, Circular, Shoulder Flexion (Assistive), Supported Shoulder Rotation, Walk Up Exercise (Active), Shoulder Internal Rotation (Active), Shoulder Flexion (Active), Shoulder Abduction (Active), Shoulder Extension (Isometric), Shoulder External Rotation (Isometric), Shoulder Internal Rotation (Isometric), Shoulder Internal Rotation, Shoulder External Rotation, Shoulder Adduction (Isometric), Shoulder Abduction (Isometric).

 

 In addition to the above the patient can also avail himself of state of the art physical therapy products such as the TUTOR system. Specifically the ARMTUTOR. The ARMTUTOR™ has been developed to allow for functional rehabilitation of the upper extremity including the shoulder, elbow and wrist. The system consists of an ergonomic  arm brace together with dedicated rehabilitation software. The ARMTUTOR™ allows the physical and occupational therapist to report on and evaluate the patient’s functional rehabilitation progress.  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 (which also includes the HANDTUTOR, LEGTUTOR and 3DTUTOR) is used by many leading rehabilitation centers worldwide and has full FDA and CE certification. See WWW.MEDITOUCH.CO.IL for more information.