Dose and Timing of Dexamphetamine Can Augment Functional Gain of Physiotherapy

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Dr. Ettlin Thierry etal of the University of Applied Science Northwestern Switzerland, Basel, Switzerland reported in a study that for early inpatient stroke rehabilitation, the effectiveness of amphetamine combined with physiotherapy varies across studies. The investigation was conducted to find out whether the recovery of activities of daily living (ADL, primary outcome) and motor function (secondary outcome) can be improved by dexamphetamine added to physiotherapy.

In a double-blind, placebo-controlled trial, 16 patients, from 918 who were screened, were randomized to the experimental group (EG, dexamphetamine + physiotherapy) or control group (CG, placebo + physiotherapy). Both groups received multidisciplinary inpatient rehabilitation. Dexamphetamine (10 mg oral) or placebo was administered 2 days per week before physiotherapy. ADL and motor function were measured using the Chedoke–McMaster Stroke Assessment (CMSA) twice during baseline, every week during the 5-week treatment period, and at follow-up 1 week, 6 months, and 12 months after intervention.

The results found that the majority of ineligible patients had too little paresis, were on anticoagulants, or had a stroke >60 days prior to entry. Participants (EG, n = 7, age 70.3 ± 10 years, 5 women, 37.9 ± 9 days after stroke; CG, n = 9, age 65.2 ± 17 years, 3 women, 40.3 ± 9 days after stroke) did not differ at baseline except for the leg subscale. Analysis of variance from baseline to 1 week follow-up revealed significant improvements in favor of EG for subscales ADL (P = .023) and arm function (P = .020) at end of treatment. No adverse events were detected.

Dr. Thierry concluded that in this small trial that was based on prior positive trials, significant gains in ADL and arm function suggest that the dose and timing of dexamphetamine can augment physiotherapy. Effect size calculation suggests inclusion of at least 25 patients per group in future studies (ClinicalTrials.gov number:NCT00572767).

When including the HandTutor and ArmTutor in physiotherapy the improvement in joint movement usually improves more rapidly.The HandTutor™ system is an active exercise based hand rehabilitation program that uses the accepted methods of impairment oriented training (IOT) with augmented feedback. The HandTutor™ evaluates and treats finger and hand movement dysfunction through exercises that encourage extension/ flexion of the finger(s) and wrist.

The HandTutor™ system consists of a safe comfortable glove, with position and speed sensors that precisely record finger and wrist motion, and dedicated rehabilitation software. The ergonomic gloves come in five sizes for both right and left hands. The rehabilitation system employs the known concept of biofeedback to give occupational and physical therapists access to an affordable user friendly hand rehabilitation package. The HandTutor™ can also be used in combination with the 3DTutor™ for arm rehabilitation. The HandTutor™ is CE medical and FDA certified

The ArmTutor™ system has been developed to allow for functional rehabilitation of the upper extremity. The system consists of an ergonomic wearable arm brace and dedicated rehabilitation software. The ArmTutor™ system allows for a range of biomechanical evaluation including speed, passive and active range of motion and motion analysis of the upper extremity. Quantitative biomechanical data allow for objective evaluation and rehabilitation treatment follow up. The ArmTutor™ 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 ArmTutor™ and its sister devices (LegTutor and 3DTutor) allows for isolated and a combination of elbow and three directional shoulder treatment. The system provides detailed exercise performance instructions and precise feedback on the patients exercise performance. 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.
The ArmTutor™ system is used by many leading rehabilitation centers worldwide and has full FDA and CE certification.

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