Constraint Induced Movement Therapy Enhanced with the HandTutor, LegTutor – Tutor Sytem

Edward Taub, PhD; Gitendra Uswatte, MA; Rama Pidikiti, MD of the Physical Medicine and Rehabilitation Service, Birmingham Department of Veterans Affairs Medical Center, Birmingham, Alabama,U.S.A. discuss the Constraint-Induced Movement Therapy or CI Therapy.
Constraint-Induced Movement Therapy or CI Therapy is a new family of intensive exercise practice rehabilitation techniques that has proven effective in  producing improvements in limb use after cerebrovascular accident (CVA) or Stroke.
The therapy involves constraining the movements or involvement in a functional task of the less-affected arm with a sling. This is done to force intensive use of the more affected limb for ninety percent of waking hours for two weeks. Inducing concentrated, repetitive practice and use of the more-affected limb is the common therapeutic factor in all CI Therapy techniques.   Transcranial magnetic stimulation and neuroimaging studies have shown that the massed practice of CI Therapy will produce cortical reorganization in the area of cortex involved in the innervation of movement of the more-affected limb. To date, CI therapy has been successful for upper limb patients: chronic and subacute CVA/  chronic traumatic brain injury (tbi). Lower limb patients with CVA/ incomplete spinal cord injury, and fractured hip.
Finally the approach has been extended to focal hand dystonia and phantom limb pain.
Stroke or Cerebrovascular accident (CVA) is the leading cause of disability in the United States and the statistics show 730,000 events every year and with over half of these individuals being left with motor disability. In a recent estimate the incidence of CVA will more than double over the next 50 years. In a 1993 estimate the annual costs of CVAs is$30 billion broken down to $17 billion (direct medical costs) + $13 billion (indirect costs because of lost productivity).
Now the American Heart Association estimates direct and indirect costs of CVA to be $43.3 billion per year.
Because of the VA population of aging World War II and Korean War veterans CVAs is a particular problem with the VA. Statistics show 22,000 admissions for an acute CVA in the VA system . Motor deficits due to Stroke result in very large costs to the VA and the Federal Government and a reduction in this CVA-related disability is now of  high VA and national health care priority.
For the upper limb, a complementary approach to CI is movement biofeedback. This approach uses customized exercise practice with instructions and feedback coming form the computer.
The HandTutor, LegTutor ArmTutor and 3DTutor has been developed as a manual therapy tool for occupational and physical therapists to effectuate massed intensive rehabilitation practice. The Tutor system allows for intensive massed practice of the upper and lower limbs through isolated and combined joint movement practice. The HandTutor, LegTutor ArmTutor and 3DTutor has been shown to improve functional outcomes in physical and occupational rehabilitation. Movement dysfunction due to CVA is but one cause of the movement dysfunctions in the upper and lower limb  that can be treated using the Tutor system. Others include Parkinson’s, Brain and spinal cord injuries, upper and lower limb surgeries, CP, MS,  Radial and Ulnar nerve injuries, development co-ordination disorders, Brachial Plexus injuries and Complex Regional Brain Syndrome.
This has meant that the newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy of both the upper limb (arms and hand therapy) and the lower limb (walking). These innovative devices 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. The upper and lower extremity Tutor system is used by PTs and OTs in leading U.S. and foreign hospitals both in-patient and out-patient. Outpatient and home care patients are also treated using the FDA and CE certified HandTutor ArmTutor, LegTutor, 3DTutor . Look up MediTouch on
Note: The CI Therapy Research Group directed by  Professor Edward Taub does not endorse any commercial products.

One response to this post.

  1. Excellent web site. Plenty of helpful information here. I am sending it to a few buddies ans also sharing in delicious. And obviously, thank you for your effort!


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