Posts Tagged ‘stroke recovery’

Central post-stroke pain syndrome (CPSP)

Central post-stroke pain syndrome (CPSP) is described by patients as sharp, stabbing, or burning pain and the experience of hyperpathia – an abnormally exaggerated subjective response to painful stimuli and allodynia – where normally non-painful stimuli evoke pain. Pharmacological therapy, magnetic stimulation, and invasive electrical stimulation are reviewed and recommendations made for the treatment of Central post-stroke pain syndrome (CPSP) in Topics in Stroke Rehabilitation, 05/08/2013. The researchers are from the Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.


Community based stroke rehabilitation and care in the UK

Dr. Fisher and team from the division of Rehabilitation and Ageing, Community Health Sciences, University of Nottingham, UK examined the delivery of community based stroke rehabilitation and care in the UK. Evidence–based community stroke services need to support the current policy of early supported discharge. The group writing in Clinical Rehabilitation.outlined the challenge of giving tailored care to individual stroke patients with stroke specialist rehabilitation including occupational and physiotherapy being tailored to clinical need following discharge from hospital.

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.

Telehealth Comes of Age

What do the following have in common?

Rural areas, medical insurance companies, 200,000 patients, cardiac patients, mental health patients, neurological telehealthdisease patients, suicide prevention and oncology follow-up care. An unlikely group of terms? Not if you consider that all of these derive a benefit or support from TELEHEALTH. In this age of high technology many medical procedures and benefits can be accomplished remotely and with as much expertise as with a face to face encounter with a professional.

Today, telehealth   is fast taking its place as a major aspect of healthcare and is understood more than ever before.

According to Jonathan Linkous, CEO of the American Telemedicine Association (ATA),  telemedicine is growing by leaps and bounds, and is due to double its current use in upcoming years.

More and more people and agencies of all kinds are joining the telehealth bandwagon.”

Telehealth used to be prevalent in rural areas mostly, where it is vital for care. However now, it is used in all parts of the country, Linkous said.

It has also attracted the interest of insurance payers. ”In the next few years,  major healthcare payers will be making interesting announcements” about telehealth, he said.

According to Linkous, tele monitoring is used by 200,000 patients nationwide. It is used to monitor one million cardiac patients a year alone, and provides 400,000 virtual visits  to mental health patients, via Skype.

The majority of patients being treated for neurological diseases are currently connected to a telesystem outside of a hospital. Nearly every major neurologic healthcare organization is using the system.

The Department of Veterans Affairs has recently begun to use telehealth to focus on mental healthcare. Beginning in July, the VA has used instant messaging in a suicide prevention program to help keep 6,000 vets online until assistance can arrive. The VA is also using telemedicine on oncology follow-up care.
When a physical therapy solution is needed and the patient lives too far from a rehabilitation facility or is back home after substantial recovery from a stroke or other limb disabling disease or surgery the TUTOR system is equipped with telerehabilitation to allow the patient to receive therapist monitored exercises.
The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are physical therapy products that consist of ergonomically designed gloves and braces with sensors connected to dedicated software. This software contains challenging games whereby the patient can use his own power to move a disabled limb or joint. The therapist then designs a specific exercise program for that patient based on his abilities.
The TUTOR system is currently in use in leading U.S. and European hospitals and clinics and is fully certified by the FDA and CE. See WWW.MEDITOUCH.CO.IL for further information.



Motor Imagery As A Tool For Stroke Rehabilitation Improvement

Motor imagery is a well known practice that refers to  mentally rehearsing  motor acts instead  of actual movement production.

 A recent study was conducted to evaluate the effect of motor imagery  on the performance of sit to stand (STS) and reaching to grasp (RTG) in patients with post stroke chronic hemiparesis.
 The study was also designed as a crossover intervention. The participants were 13 people with a mean age of  68.9  with chronic hemiparesis that were enrolled in the day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and RTG, these functions were mentally practiced by the patients for 15 minutes three times a week for four weeks. Half of the subjects  practiced STS mentally, while the other half practiced the RTG imagery protocol. Then, the participants in each group switched over to practice the other function for the next 4 weeks. All of the sessions were performed under supervision according to a protocol that was established beforehand. Measurements of real performance took place two times before and two times immediately after each practice session. For STS, the Tetrax Balance System was the measure used to judge the speed of performance and the weight distribution between the legs. RTG was appraised by a “kinematic” glove which included speed variables of the hand.
The results of the study showed  a significant decrease  in the values of STS duration however weight distribution between the legs wasn’t  affected by the intervention. For RTG, a very significant improvement resulted both in the mean and the maximum reaching speed.
The conclusions reached by this study were that in individuals that have chronic hemiparesis, the practice of motor imagery   can positively affect real performance.
When physical therapy is indicated for stroke rehabilitation the TUTOR system has shown effective results. The HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR are ergonomic wearable physical therapy products together with powerful dedicated rehabilitation software. The system is designed for upper and lower movement dysfunction. The TUTORs are designed to allow stroke patients intensive exercises in an entertaining and challenging fashion. Physical and occupational therapists monitor the progress of the patient and then design a customized exercise program.
Fully certified by the FDA and CE the TUTORs are currently in use in leading U.S. and European hospitals and clinics. They can also be used at home through telerehabilitation.
See WWW.MEDITOUCH.CO.IL for further information.

Post Stroke Physical Therapy Exercise Products

Two-thirds of the 700,000 Americans who have a stroke each year survive and require rehabilitation. But fewer than one in three post-stroke patients undergoing physical therapy perform the at-home exercises their physical therapists recommend.

A team of researchers at Ohio State University is using a $653,000 grant from the Patient-Centered Outcomes Research Institute to develop a more fun and effective way for patients to work on regaining movement and mobility in their upper limbs.

Lynne Gauthier, an assistant professor of physical medicine and rehabilitation, is leading the team creating a video game for the Microsoft Kinect that the team hopes could expand access to a specific kind of rehabilitation called constraint-induced movement therapy. The game would allow patients with mild-to-moderate upper-limb impairment to perform guided CI therapy in their homes.

In standard stroke rehabilitation, patients only get a few hours of therapy each week and tend to develop what’s known as “nonuse,” in which they avoid use of the affected arm because it’s clumsy and awkward. CI therapy was designed to overcome nonuse by restraining the unaffected arm and upping the intensity of therapy to several hours a day over a period of two weeks.

Studies have demonstrated the ability of CI therapy to improve upper extremity function in patients shortly after stroke and after time has passed. Several studies have also shown changes in brain activity associated with the therapy.

Despite a body of research that suggests CI therapy is more effective than standard rehabilitation, it hasn’t become standard of care because it costs about $6,000 and isn’t typically covered by insurance, Gauthier said, so only a small number of specialty clinics offer it. Less than one percent of patients who are eligible for it are able to travel to those clinics and pay for it, she added.

Gauthier said her team’s objective is to develop and pilot a home-based program that retains the fundamental principles of CI therapy but changes the way it’s delivered, so more patients can access it for a lower cost ($500 or less). The video game the team is developing targets both subacute stroke patients who have completed inpatient rehabilitation as well as patients with chronic post-stroke impairment.

The game uses Microsoft Kinect’s motion capture technology to guide patients through a series of therapeutic exercises set in a river adventure theme, Gauthier said. Patients would visit a clinic for initial consultation and the game would act as a consultant to guide them through exercises at home. Patients would also be given a restraint mitt to encourage them to use their affected side more often in daily activities.

“A lot of these kinds of rehab games are basically about just getting the person to move a lot,” she said. “But we’re trying to make it so that the game would stimulate what the therapist would do. Just as a therapist would make a task harder when the person improves, the game would do the same thing.”

To do that, Gauthier is working with a cross-disciplinary team made up of a computer scientist, an electrical engineer, a biomechanist, two physical therapists and Gauthier, a psychologist and neuroscientist.

Eventually the team will create computer algorithms that would allow the program to track patients’ progress over time and provide performance feedback to patients and therapists. For the first year of the grant, though, it’s focused on game design.

Over the next several months, the team will work with patients and therapists to refine the game; the second year of the grant will focus on testing it in patients’ homes. “We feel it’s very important to involve stakeholders,” she said. “We don’t really know what the therapist response is going to be, but we are trying to involve them to make sure that we design a product that they would actually use.”

Kinect joins other physical therapy solutions already helping patients recover their lost mobility strengths. One such product is the TUTOR family of products. The HANDTUTOR, ARMTUTOR,LEGTUTOR and 3DTUTOR are ergonomically designed comfortable gloves and braces which are placed strategically on affected limbs and allows the patient to get intensive self initiated exercises via sensors that are connected to dedicated software.

The ARMTUTOR specifically trains the upper limb through dedicated software games such as : snowman, asteroid attack, car race and others. The exercises are designed to increase brain activity. Therapists monitor progress and then design a customized exercise program for that patient giving him appropriate feedback. The TUTORs are currently in use in leading U.S. and European hospitals and clinics and are available through telerehabilitation in the patient’s home.

The TUTORs can be used by adults as well as children from the age of 5 and up and are fully certified by the FDA and CE.

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


Disability, Depression and Rehabilitation

Disabilities make it harder to take part in normal daily activities. They may limit what you can do physically or mentally, or they can affect your senses. Disability doesn’t necessarily mean unable, and it isn’t a sickness. Most people with disabilities can – and do – learn, work, play,  and enjoy full healthy lives. Mobility aids and assistive devices can sometimes make all the difference., About one in every five people in the United States has some kind of a disability. Some people are born with a disability. Some get sick or have an accident that results in a disability. Some people develop disabilities as they age. Almost all of us will have a disability at some point.
 Disabilities can lead to depression. Depression is a serious medical illness that involves the brain. Being “down in the dumps” or “blue” for a few days is not what depression is about.   If you are one of the more than 20 million people in the United States who have depression, the feelings do not always go away. They persist and can interfere with your everyday life.
Symptoms can include:
Loss of interest or pleasure in activities you used to enjoy,
Difficulty sleeping or oversleeping,
Change in weight,
Feelings of worthlessness,
Energy loss,  and even
Thoughts of death or suicide
Depression is a disorder of the brain. There are a variety of causes, including environmental, genetic, psychological, and biochemical factors. Depression can start between the ages of 15 and 30, and is much more common in women. Postpartum depression after the birth of a baby can also cause major depression. Some people get an affective disorder in the winter or around the holidays especially if they are separated from family and friends. Depression is one part of bipolar disorder.
There are effective treatments for depression, including antidepressants, talk therapy and physical rehabilitation for a disability. When the disability is a result of a stroke, brain or spinal cord injury, Parkinson’s disease, MS, CP or any other upper or lower limb surgery or disease efforts should be made to employ the most effective physical, solution available. This may encourage the best way to return to the pre event emotional status. One of the most efficient physical therapy products available today is the TUTOR system by MEDITOUCH. The MEDITOUCH rehabilitation system consists of the HANDTUTOR, ARMTUTOR, LEGTUTOR and 3DTUTOR. These are ergonomic wearable devices together with powerful dedicated rehabilitation software. The system is indicated for patients in rehabilitation centers, private clinics and the home and can be supported by telerehabilitation. It is designed for those that have head, trunk, upper and lower extremity movement dysfunction.
The system consists of motivating and challenging games that allow the patient to practice isolated and/or interjoint coordination exercises. The dedicated software allows the therapist to fully customize the exercises to the patient’s ability. Most important is that the TUTOR system optimizes the patient’s motor, sensory and cognitive performance allowing him to better perform everyday functions again and thereby to reduce depression.
Currently in use in leading U.S. and European hospitals and clinics the TUTORs are fully certified by the FDA and CE.
See WWW.MEDITOUCH.CO.IL for further information.