The LegTutor–an Excellent Therapy for MMT Issues

Toes on a right foot

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Drs. Y. Hara , K. Matsudaira, N. Hara and H.Oka of the Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo writing in J Orthop Sci. 2011 Sep 16. have found that although extensor hallucis longus (EHL) strength has been identified as a primary predictor of L5 nerve root radiculopathy and deep peroneal nerve palsy, assessment of EHL strength is commonly overlooked. This is mainly due to the lack of an objective and accurate method for evaluation, since manual muscle testing (MMT) has not been well utilized. A study of the reliability of evaluating MMT in various toe positions was performed.

To determine the reliability and validity of MMT for great toe extension, 40 normal volunteers (80 toes) with good muscle strength were recruited. Each subject was examined with MMT at the MTP joint (MTPp) and IP joint with various positions of the MTP joint (maximal extension: IPp-e, neutral position: IPp-n, maximal flexion: IPp-f) by two examiners. Inter-observer reproducibility was calculated for each MMT by κ values. Correlations between the great toe length and great toe extensor strength in each position, and between the angle in maximal extension of the MTP and great toe extensor strength in each position were examined using Spearman’s correlation test.

The results they found were that the great toe extensor strength was highly maintained in MTP measurement. Correct detections in each position (MTPp, IPp-e, IPp-n, IPp-f) were 96.3 and 96.3; 45.0 and 32.5%; 53.8 and 33.8%; and 50.0 and 61.5% for the first and second observer, respectively. The inter-observer variability for great toe extensor strength was highly maintained in MTP measurement (κ values = 1.00). The κ value of each position was 0.69, 0.35, and 0.28 for IPp-e, IPp-n, and IPp-f, respectively. There were no correlations between great toe length or angle in extension of the MTP and great toe extensor strength in each position.

This study demonstrated that MTPp was much superior to the IP joint in the MMT procedure for great toe extension.

The LegTutor™ system has been developed to allow for functional rehabilitation of the lower extremity. The system consists of an ergonomic wearable leg brace and dedicated rehabilitation software. The LegTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the lower extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. 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. The exercises are designed in the form of challenging 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.

The LegTutor™ is an excellent aid for MMT and also 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 patients 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 used by many leading rehabilitation centers worldwide and has full FDA and CE certification.


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