Posts Tagged ‘lower limb’

Neuronal rearrangement and recovering of movement ability post stroke

Stroke may lead to various degrees of neurological deficit and long term upper and lower limb movement disability. Writing in  international Journal of Stroke, 04/09/2013 Dr. Varsou O et al Aberdeen Biomedical Imaging Centre, The University of Aberdeen, Aberdeen, UK discuss how functional connectivity magnetic resonance imaging may shed lights on neuronal plasticity following a focal brain injury.


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 weaknessGuillain-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.

The Connection Between MS and Vitamin D

Researchers conducted a study that appeared in the Journal of Neurology, Neurosurgery and Psychiatry and published by the Jerusalem Post on December 23, 2012 in which they suggest that pregnant women take vitamin D supplements to ward of  MS, as not enough of the vitamin is produced in the skin from the sun’s ultraviolet rays. It has been a known fact that  MS can be contracted by people living in countries with little sunlight. The risk of developing MS is highest during April and lowest during October according to available analysis.
The researchers compared previously published data on almost 152,000 people with MS with expected birth rates for the disease in a bid to find out if there was any link between country of birth and risk of developing MS. At latitudes greater than 52 degrees from the equator, insufficient ultraviolet light of the correct wave length reaches the skin between October and March to enable the body to manufacture enough vitamin D during the winter months.
There was a significant increase in risk among those born in April and May and a significant lower risk among those born in October and November. The studies were only conducted in the northern hemisphere and that should be considered in this analysis.
The researchers state that through combining existing datasets for month of birth and subsequent MS risk, this study provides the strongest evidence to date that the month of birth effect is a genuine one. This supports previous hypotheses and adds weight to the argument for early intervention studies that recommended supplementing the diet with vitamin D to prevent MS.
When MS, nevertheless, develops its limb disabling symptoms the most effective physical therapy solution should be used. Such a solution can be found in the TUTOR system of physical therapy products.
 The recently developed HANDTUTOR and its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) have become a key system in neuromuscular rehabilitation for stroke victims and those recovering from MS,brain and spinal injuries, Parkinson’s, 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 TUTORs 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 rehabilitation games to set a new target for this movement in terms of the patient’s ability to move their 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 moving their affected limb again. The Tutor system provides exercises that are challenging and motivating and allow for repetitive and intensive exercise practice.
The Tutor system is 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.

Five Ways to Relieve Arthritis Pain

Arthritis has no known cure–just relief from pain. It’s called– exercise. Below are 5 exercises that are designed to bring joint relief, relieve stress and assist in weight loss. They can be fun too.
Doctors say that physical activity  is the best medicine  there is for arthritis pain relief, .
Patience White, M.D., chief public health officer of the Arthritis Foundation and professor of medicine and pediatrics at the George Washington University School of Medicine states that exercise can decrease pain, especially for people with osteoarthritis which is the most common type of arthritis.
 In the Cochrane Database of Systematic Reviews it was reported that exercise, such as walking, was  as effective  as drugs like Aleve or Advil in reducing knee pain.
By working out regularly it  may prevent sore joints and stop arthritis from getting worse.
Kevin Fontaine, Ph.D., assistant professor of medicine at the Center for Mind-Body Research at Johns Hopkins University School of Medicine in Baltimore states that  physically active people  have a higher quality of life and are less likely to become disabled or have days with lots of pain.
 Workouts also keep off the pounds. Obesity can increase the risk of arthritis and/or make its symptoms worse.
 Just 20 minutes three times a week or two 10 minute intervals is enough to make a difference according to Arthritis Today, the journal of the Atlanta-based Arthritis Foundation.
There are also new medications that can help relieve arthritis pain and swelling allowing patients to work out according to  Halsted Holman, M.D., professor emeritus of medicine and former director of the Stanford Multi-Purpose Arthritis Center at Stanford University’s School of Medicine.
Generally it is necessary to begin exercising only with a physician’s agreement.
A workout should be a challenging experience, but not painful enough to cause injury, Dr. Holman says.
 If you have sore joints or muscle pain that continues for even two hours after exercising or if the pain is worse the next day then the exercises were overdone. In that case the workout should be shortened or done more gently.
Here are 5 arthritis exercises that are sure to ease  arthritis symptoms:
1. Walking
 Walking is known to strengthen muscles, which in turn helps shift pressure away from the joints, and reduces pain.
 It also brings nourishing oxygen to the  joints by compressing and releasing cartilage in the knees.
 The Arthritis Foundation recommends walking 10 minutes at least 3-5 days a week to start.
As you progress, take longer walks and include short bursts of speed getting to a moderate pace until you are able to walk 3-4 miles an hour.
 People with serious hip or knee problems should first check with their doctor before beginning a walking program.
2. Water Exercise
How it helps: The University of Washington Department of Orthopedics and Sports Medicine recommends warm water – between 83˚ F and 90˚ F – to help relax  muscles and decrease pain.
Swimming and aerobics exercises in water are good for stiff, sore joints.
Water also supports the body as one moves. This reduces stress on the knees, hips  and spine, and offers resistance without any weights.
Water exercises are  ideal for people who need to relieve severe arthritis pain in knees and hips.
Arthritis Today quotes “Water provides 12 times the resistance of air, so one is  really strengthening and building muscle”.
When immersed in the water don’t pedal faster than 50-60 revolutions a minute. Add resistance  after a warm up period of  five minutes and don’t add more pedaling than you can handle.
Matthew Goodemote, head physical therapist at Community Physical Therapy & Wellness in Gloversville, N.Y.  says that indoor cycling is one of the best ways to get a cardiovascular workout without stressing weight-bearing joints.
 Since there’s no need to lean the bike to turn a stationary bike is  a good option for people with balance issues – a common problem among some arthritis patients.
 When starting this arthritis exercise be sure that the seat height is at a position which allows the knee to be completely straight  when the pedal is at the lowest point, according to the University of Washington Department of Orthopedics and Sports Medicine.
One should not pedal faster than 50-60 revolutions per minute. A warm up period of five minutes should be allowed at first. Then patients should start 5 minute sessions 3 times a day. Then increase gradually to 7 and up to 20 minutes a day providing there is no pain.
 People with very painful knees should avoid indoor cycling, because it can aggravate the condition.
4. Yoga
 Steffany Haaz, MFA, a certified movement analyst, registered yoga teacher and research coordinator at Johns Hopkins Arthritis Center says that beginner yoga classes that have simple, gentle movements gradually build balance, strength  and flexibility  which are elements that can be  beneficial for people with arthritis.
Yoga  reduces inflammation, increases energy and, in general, allows for a more positive mental outlook, according to Psychosomatic Medicine, an Ohio State University study published in their journal.
To start, take a class at a  gym,  community center or yoga studio. You can find a certified teacher through the Yoga Alliance, the accrediting body for yoga instructors worldwide. It is important to tell the instructor before class about your  arthritis  so that they can  modify poses to accommodate your limited mobility.
For those that prefer doing Yoga at home,  there is a company called Gaiam that produces yoga videos and recently collaborated with the Mayo Clinic to produce a DVD entitled  “The Arthritis Wellness Solution” . It contains tips from specialists and a segment showing specific yoga for arthritis sufferers  and includes meditation exercises which are designed to enhance circulation and  relieve tension which helps relieve arthritis pain.
 Yoga should never hurt. If it does that means it’s overdone.
Straps, blankets and chairs can be used  to accommodate people with  limited range of motion, strength or balance.
5. Tai Chi
This traditional style of Chinese martial arts  goes back centuries and features slow, rhythmic movements to induce mental relaxation and enhance balance, flexibility and strength.
Tai chi is very valuable to arthritis patients because its movements are very slow and controlled. They put little force on the joints.
Some studies have shown that Tai Chi can improve life satisfaction, mental well-being  and perceptions of health, which oppose negative effects of  pain associated with arthritis.
The November 2009 issue of Arthritis Care & Research, a journal of the American College of Rheumatology has an article that describes Tai Chi as being beneficial for knee pain. Another research study by a Tufts University group found that Tai Chi was especially helpful for patients that were over 65 and had knee osteoarthritis.
According to another university’s Orthopedics and Sports Medicine department, Tai chi should preferably be done in the morning,  when there is  least pain and stiffness, when you’re not tired and when the arthritis medication is most effective.
Taking a warm shower is always a good idea before exercise if joints are stiff.
One of the most effective exercise programs for arthritis sufferers is by using the TUTOR system of physical therapy products. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR were originally designed to help patients that suffered a stroke, brain injury, Parkinson’s or other upper and lower limb disabilities. However much relief has been gained for arthritis patients as well  who would like a challenging and entertaining system of exercising arthritic joints. The TUTORs are ergonomically designed gloves and braces that contain sensors connected to sophisticated exercise games. The physical and occupational therapists monitor and record the progress made and design a customized exercise program for that patient.
Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE. They are also available in the home through the use of telerehabilitation and can be used by adults and children from the age of 5 and up.
See WWW.MEDITOUCH.CO.IL for further information.

Multiple Sclerosis Symptom Guidelines

People who develop Multiple Sclerosis (MS) are usually between 20 and 40 and display at least two symptoms before being seen by the doctor.
Blurred or double vision
Weakness in one or more limbs
Cognitive difficulties
Sudden onset of paralysis
Slurred speech
Lack of coordination
 Early symptoms of MS include:
Loss of balance
Later, as the disease progresses, other symptoms may appear such as fatigue, muscle spasms, sensitivity to heat, sexual disturbances and changes in thinking or perception.
Fatigue is typically present in the afternoon and may include increased muscle weakness,  mental fatigue, or sleepiness.  Many patients with MS complain of  fatigue even after a good night’s sleep.
Heat sensitivity which can worsen symptoms  occurs in most people with MS.
Spasticity. Muscle spasms are a common  symptom of MS. Spasticity  affects the muscles of the legs and arms, and may interfere with being able to move those muscles freely.
Dizziness. A feeling of “off balance” or lightheadedness or that the surroundings are spinning is common; this is called vertigo. These symptoms are due to damage in the complex nerve pathways that coordinate vision and  are needed to maintain balance.
Impaired thinking  occurs in about half of the people with MS. This can manifest itself by slowed thinking, decreased concentration, or decreased memory.  10% of people with the disease have it so severe  that they cannot carry out  tasks of daily living.
Vision problems can include blurring or graying of vision or blindness in one eye.
Abnormal sensations. Many  MS patients experience  sensations such as numbness, “pins and needles,”  burning, itching,  stabbing, or tearing pains. Even though these symptoms are aggravating, they are not life-threatening and can be  treated.
Speech and swallowing problems in people with MS are caused by damaged nerves that normally would aid in performing these tasks.
Tremors are fairly common in people with MS and can be debilitating and difficult to treat.
Difficulty walking is among the most common symptoms of MS.  This  is related to muscle weakness and/or spasticity.   Balance problems or numbness in the  feet can also make walking difficult.
There are other rare symptoms which include breathing problems and seizures.
 The symptoms can be divided into three categories: primary, secondary, and tertiary.
Primary symptoms are a result of the  impairment of the transmission of electrical signals to muscles  and the organs of the body.  These symptoms include: tremors, weakness,  tingling, paralysis, loss of balance, numbness, vision impairment and bladder or bowel problems. These can be kept under control through the use of medication and rehabilitation.
Secondary symptoms are a result of primary symptoms. For example, paralysis  can lead to bedsores  and bladder or urinary incontinence  can cause frequent urinary tract infections. Although these symptoms can be treated,  the ideal goal is to  treat the primary symptoms.
Tertiary symptoms include psychological, social,  and vocational complications that are associated with the primary and secondary symptoms. Depression can be a common problem for those  with MS.
Deterioration of the protective sheath (known as Demyelination) that surrounds nerve fibers, can occur anywhere in the brain or spinal cord.  Demyelination in the nerves that communicate with the muscles causes problems with movement (called motor symptoms) and demyelination along the nerves that carry  messages to the brain causes disturbances in sensation.
Multiple sclerosis is a varied and unpredictable disease. For many people, it starts with a single symptom, followed by months or longer without any progression of symptoms. In others, the symptoms can become worse within weeks or months.
There are many symptoms, as stated above, but it is important to know that a given individual may only experience some of the symptoms and not others. With some the symptom may occur and then disappear. It is not wise to compare one MS patient with another.
When the symptoms reach a level where physical rehabilitation can be helpful the most effective solutions should be incorporated into the patient rehabilitation treatment program. Such solutions would include the TUTORs. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients in rehabilitation centers,, private clinics and the home supported by telerehabilitation. The TUTORs have been used to create an intensive exercise program for patients who have had MS or stroke, Parkinson’s disease, head or brain injuries, CP and other upper and lower limb disabilities.
Currently in use in leading U..S. and European rehab facilities the TUTORs are fully certified by the FDA and CE.
See WWW.MEDITOUCH.CO.IL for further information.

Obesity as a Complication to Knee Arthroplasty

Hawaiian woman

Hawaiian woman (Photo credit: Wikipedia)



In a  study by  Gino M.M.J. Kerkhoffs, MD, PhD, from the Department of Orthopedic Surgery, Orthotrauma Research Center Amsterdam, University of Amsterdam, the Netherlands and his colleagues, about obesity as a well known risk factor for total knee arthroplasty.  The rates of obesity and total knee arthroplasty have increased with the increasing prevalence of obesity. It is not clear whether obesity itself is a risk factor for poor outcomes following total knee arthroplasty. Differing results have been reported  for complications and revision rates among obese or nonobese patients who have undergone total knee arthroplasty.
This is a  study examining outcomes after total knee arthroplasty to determine if obesity  contributes to poorer short-term and long-term outcomes.
According to a meta-analysis published in the October 17, 2012 issue of the Journal of Bone and Joint Surgery obese patients are more than 2 times likely to incur deep infection, nearly twice as likely to incur infection after a total knee replacement, and somewhat more likely to require a surgical revision than those who are not obese.
The surgical outcomes for total knee arthroplasty among those with a body mass index (BMI) of 30 kg/m2 or more were surveyed together with outcomes for patients with BMIs lower than 30 kg/m2.
The authors found that obesity was a persistent risk factor for infection.
 According to Marc DeHart, MD, from Texas Orthopedic in Austin and a clinical assistant professor at Texas A&M Health Science Center in Bryan, as told to Medscape Medical News “The study is the highest level of science that we have in orthopedics. Dr. DeHart was not associated with the study and stated “It’s hard to do a blinded study, and that’s the only  study that would be better.”
Although specific studies that looked at knee replacement outcomes with obese and nonobese patients have shown mixed results, with some showing no difference between the two patient groups and others that  reported higher levels of complications, Dr. DeHart said the current research confirms what most orthopaedic surgeons have noticed in their practices.
 Orthopedic surgeons understand people who are heavier are harder to operate on and also have other issues related to their health. It takes longer to do cases, it’s harder to get them out of the hospital, and  they have more anxiety and more stress according to Dr. DeHart.
He stated that the infection rates could have been even higher if the authors compared patients with BMIs of 35 or 40 kg/m2 and up to patients of normal weight.
The study authors agree that there is a lack of definitive conclusions from earlier studies and  suggest that they were underpowered.
Even with a higher complication rate, total knee replacements allow for an important improvement for patients with a high BMI and it’s  still worth doing knee replacements in most of these patients because they have pretty good improvement according to Dr. DeHart.
For those people for whom it works well, they’re  very happy.
Patients recovering from knee surgery, obese or not, benefit from the latest physical therapy products such as the LEGTUTOR. The LEGTUTOR consists of a comfortable ergonomically designed leg brace that contains position and speed sensors record precise 3 dimensional knee movements. The LEGTUTOR has a range of motion limiter that limits the dynamic range of extension and flexion of the knee. Special rehabilitation games allow the patient to exercise the limb’s speed and accuracy of movement.
The LEGTUTOR  together with its sister devices (HANDTUTOR, ARMTUTOR and 3DTUTOR) are currently in use in leading U.S, and European rehabilitation hospitals and clinics. They are fully certified by the FDA and CE and are available for use by adults and children from the age of 5 and up. The TUTORs can also be used at 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.