Posts Tagged ‘stroke rehab’

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.

Advertisements

Brain Stimulation Helps Parkinson’s Patients

There are several medications available to Parkinson’s patients to relieve their symptoms but when they aren’t effective a procedure called deep brain stimulation (DBS) is sometimes used. DBS consists of surgically implanting electrodes in deep brain structures that help control movement, and then delivering stimulation through the electrodes with a device very much like a pacemaker. One common target is the subthalamic nucleus (STN). The problem has been that although DBS can relieve movement problems it may incur problems in the patient’s cognition. Doctor’s do not fully understand the reasons for that.
A theory is being investigated by Dr. Joel Perlmutter, a professor of neurology and radiology at Washington University in St. Louis, Mo. to try to improve DBS and reduce its side effects. He has been targeting the stimulation to one particular site in the brain and avoiding another nearby site. Funding for the research is being provided from the National Institute of Neurological Disorders and Stroke through a recent congressional act called ARRA.
Studies show that stimulating the dorsal part (top) of the STN  can lead to desirable activity in the brain’s motor pathways, while stimulating the ventral part (bottom) can lead to negative activity in other brain pathways that are involved in cognition.
Dr. Perlmutter, together with his team, will examine Parkinson’s patients who have received DBS to the STN, and to try to pinpoint the location of the electrodes – which can possibly change after surgery. Their purpose is to  analyze how electrode location affects the  motor symptoms, cognitive function and cortical activity. In order to  locate the electrodes, the team instituted a method that involves reconstructing 2-D brain scans into 3-D maps, and then using landmarks in and around the STN for orientation.
From this research there should be a better understanding of how DBS works and improvements made in  treating Parkinson’s. This will include a better design and targeting of the electrodes. Besides that, the research is expected to yield insights into the function of the STN and how it is involved in other neurological disorders.
When Parkinson’s disease causes movement disorders physical therapy solutions become vital. The HANDTUTOR has been in the forefront of Parkinson’s patient exercise therapy for some time now. The HANDTUTOR consists of a safe comfortable glove with position and speed sensors that precisely record finger and wrist motion. Rehabilitation games allow the patient to exercise Range of Motion, speed and accuracy of movement opposition and pinch movement practice. The HANDTUTOR facilitates evaluation and treatment of isolated and combined finger/s and wrist joint.
Together with its sister devices (ARMTUTOR, LEGTUTOR, 3DTUTOR) the HANDTUTOR is currently in use in leading U.S. and European hospitals and rehabilitation clinics. They are fully certified by the FDA and CE and are available for use in the patient’s home through telerehabilitation.
See WWW.MEDITOUCH.CO.IL for further 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:
Tingling
Loss of balance
Numbness
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.

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.